Blood pressure reduction with HMG-CoA reductase inhibitors in renal transplant recipients

Blood pressure reduction with HMG-CoA reductase inhibitors in renal transplant recipients.BackgroundBesides lowering lipid levels, 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) modulate endothelial function and decrease vascular tone. The effect of statin therapy on blood pressure has not been previously examined in renal transplant recipients.MethodsWe identified 113 stable recipients with graft survival>1 year and started on a statin ≥1 year post-transplant with no subsequent alteration in type or dose, as well as ≥6 months' follow-up post-statin introduction along with no changes in antihypertensive medication type or dosage. This “statin” group was compared to a control group matched 1:1 by age, gender, donor source, year of transplant, and time since transplant who met identical criteria but were not begun on a statin. Baseline, 6 months, and 12 months outpatient blood pressure were reviewed and compared along with other possible blood pressure predictors. A multivariate analysis was performed controlling for other influences on blood pressure change.ResultsBlood pressure and baseline characteristics other than lipid levels were similar in the two groups. The systolic, diastolic, and mean arterial blood pressure decreased by 7mm Hg (P = 0.005), 3mm Hg (P = 0.05), and 4mm Hg (P = 0.007), respectively, at 12 months' post-statin introduction, while no blood pressure change was seen in the control group (P = NS). At 12 months, the systolic, diastolic, and mean arterial blood pressures were lower in the statin group compared to the control group (P = 0.05, 0.03, and 0.02, respectively). These changes in blood pressure were independent of changes in serum lipid levels.ConclusionRenal transplant recipients exhibit a significant blood pressure reduction associated with statin therapy. This finding has important mechanistic and clinical implications in the management of cardiovascular disease risk factors in this population