Popat Apurva, Yadav Sweta
Internal Medicine, Marshfield Clinic Health System, Marshfield, USA.
Cureus. 2024 Oct 19;16(10):e71876. doi: 10.7759/cureus.71876. eCollection 2024 Oct.
Hypertension and hypercholesterolemia are the two most common modifiable risk factors for cardiovascular disease (CVD). Current guidelines recommend treating these risk factors simultaneously rather than in isolation. One prominent way to simultaneously treat the risk factors is by concurrently administering blood pressure (BP) lowering and lipid-lowering drugs (statins). However, there is still a controversy on which antihypertensive drugs to combine with statins for effective treatment. Therefore, the present meta-analysis assessed the efficacy of various antihypertensive agents combined with statins on BP and low-density lipoprotein cholesterol (LDL-C). PubMed, MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar databases were searched thoroughly for records published in English up to February 2024. According to the PICOS (Patients, Intervention, Comparison, Outcomes, and Study design) criteria, randomized controlled trials (RCTs) evaluating the effectiveness of combination therapy of antihypertensives and statins in treating hypertension and hypercholesterolemia were eligible for inclusion. Furthermore, statistical analyses were performed using Review Manager software (RevMan version 5.4.1), and quality assessment was performed using the Cochrane risk of bias tool. Eight RCTs comprising 1,182 patients with hypertension and hypercholesterolemia were included. Compared to statin monotherapy, no significant difference in the change of LDL-C levels was observed in patients receiving combination therapy of angiotensin receptor blockers (ARBs) with statins (MD, -3.98; = 0.56) and BBs with statins (mean difference [MD], -0.47; = 0.90). However, calcium channel blockers (CCBs) combined with statins showed a significantly greater reduction in LDL-C levels than statins alone (MD, -8.0; = 0.0008). Similarly, patients treated with CCBs and statins had a considerable decrease in diastolic blood pressure (DBP) than those treated with antihypertensives only (MD, -6.37; = 0.04). On the other hand, patients receiving antihypertensive drugs only demonstrated significantly better reductions in systolic blood pressure (SBP) than patients treated with combination therapy of ARBs and statins (MD, 2.88; < 0.00001). Furthermore, we found that triple combination therapy was associated with better BP-lowering effects than double combination therapy of antihypertensive and statin (MD, -15.15; < 0.00001 for SBP; and MD, -10.28; < 0.00001, for DBP). No significant difference was recorded in the incidence of treatment-emergent adverse events. Concurrent administration of antihypertensives and statins has similar effects on BP and LDL-C as the use of either drug alone. Furthermore, triple combination therapy (two antihypertensives and a statin) is associated with better BP-lowering effects than double combination therapy (one antihypertensive and a statin).
高血压和高胆固醇血症是心血管疾病（CVD）最常见的两个可改变风险因素。当前指南建议同时治疗这些风险因素，而非单独治疗。同时治疗这些风险因素的一个主要方法是同时服用降压药和降脂药（他汀类药物）。然而，对于将哪种抗高血压药物与他汀类药物联合使用以进行有效治疗仍存在争议。因此，本荟萃分析评估了各种抗高血压药物与他汀类药物联合使用对血压和低密度脂蛋白胆固醇（LDL-C）的疗效。全面检索了PubMed、MEDLINE、Cochrane对照试验中央注册库（CENTRAL）和谷歌学术数据库，以查找截至2024年2月以英文发表的记录。根据PICOS（患者、干预措施、对照、结局和研究设计）标准，评估抗高血压药物与他汀类药物联合治疗高血压和高胆固醇血症有效性的随机对照试验（RCT）符合纳入条件。此外，使用Review Manager软件（RevMan版本5.4.1）进行统计分析，并使用Cochrane偏倚风险工具进行质量评估。纳入了8项RCT，共1182例高血压和高胆固醇血症患者。与他汀类药物单药治疗相比，接受血管紧张素受体阻滞剂（ARB）与他汀类药物联合治疗的患者（MD，-3.98；P = 0.56）以及接受β受体阻滞剂（BB）与他汀类药物联合治疗的患者（平均差[MD]，-0.47；P = 0.90），LDL-C水平变化无显著差异。然而，钙通道阻滞剂（CCB）与他汀类药物联合使用时，LDL-C水平的降低幅度显著大于单独使用他汀类药物（MD，-8.0；P = 0.0008）。同样，接受CCB与他汀类药物治疗的患者舒张压（DBP）较仅接受抗高血压药物治疗的患者有显著降低（MD，-6.37；P = 0.04）。另一方面，仅接受抗高血压药物治疗的患者收缩压（SBP）的降低幅度显著优于接受ARB与他汀类药物联合治疗的患者（MD，2.88；P < 0.00001）。此外，我们发现三联联合治疗比抗高血压药物与他汀类药物的双联联合治疗具有更好的降压效果（SBP的MD，-15.15；P < 0.00001；DBP的MD，-10.28；P < 0.00001）。治疗中出现的不良事件发生率无显著差异。同时服用抗高血压药物和他汀类药物对血压和LDL-C的影响与单独使用任何一种药物相似。此外，三联联合治疗（两种抗高血压药物和一种他汀类药物）比双联联合治疗（一种抗高血压药物和一种他汀类药物）具有更好的降压效果。
