Simvastatin in the treatment of hypercholesterolaemia in patients with essential hypertension

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Mortality from coronary artery disease is a common problem in treated hypertensive patients, and these people have a high prevalence of elevated cholesterol levels. A study was undertaken to determine whether cholesterol could be lowered effectively without major side effects in patients with treated hypertension. Forty-nine patients (mean age 67.6 years) with cholesterol>5.5 mmol/l were placed on a reduced-fat (< 30% of calories from fat with a ratio of polyunsaturated to saturated fats of<1) diet for 3 months. If the cholesterol was between 5.5 and 7.5 mmol/l and total cholesterol divided by high-density lipoprotein cholesterol was >4.5, the patients were randomly allocated either to the simvastatin (24 patients) or the placebo group (25 patients). Diet and placebo caused minor and insignificant falls in cholesterol and no change in triglycerides or lipids. Treatment with simvastatin reduced cholesterol levels from 6.85 to 4.75 mmol/l (P<0.001), triglycerides from 2.7 to 2.1 mmol/l (P<0.01), low-density lipoproteins from 4.6 to 2.6 mmol/l (P<0.001) and high-density lipoproteins rose from 1.09 to 1.18 mmol/l (P<0.01). Total cholesterol divided by high-density lipoprotein cholesterol fell from 6.3 to 4.0 (P<0.001)The drug was well tolerated and the side-effect profile did not differ from the placebo in clinical or biochemical events. The active drug was stopped in one patient (abdominal pain, dizziness, headache, tiredness) and in two patients taking the placebo (elevated creatine phosphokinase, cardiovascular collapse)Simvastatin effectively lowered total cholesterol and improved the lipoprotein profile. The dose required in most patients was 40 mg/day. Simvastatin may be an acceptable drug to improve the lipoprotein profile in order to determine whether this improves the prognosis in patients treated for hypertension

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