PubMed · 10184933
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1998. Primary prevention.. https://pubmed.ncbi.nlm.nih.gov/10184933/
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Although lowering blood pressure (BP) reduces aortic stiffness, achieving the recommended BP goal can be difficult. Recent studies have shown that short-term use of statins can reduce BP significantly. To determine the long-term effects of statins on BP and aortic stiffness, a single-blind randomized prospective study was performed on 85 hyperlipidaemic hypertensive patients whose BP was insufficiently controlled by antihypertensive therapy. Every 3 months, aortic stiffness was assessed by measuring pulse wave velocity (PWV). Patients were randomly allocated to groups treated with pravastatin, simvastatin, fluvastatin, or a nonstatin antihyperlipidaemic drug. No significant differences in patient characteristics, kinds of antihypertensive drugs, BP, ankle brachial index, PWV, or serum lipid, creatinine, or C-reactive protein levels were found between the four groups at the start of the study. During the 12-month treatment period, PWV did not change in the pravastatin group or nonstatin group, but it was transiently reduced in the simvastatin group and significantly decreased in the fluvastatin group, even though the doses of the statins used in this study were lower than the usually prescribed dose. All four antihyperlipidaemic drugs significantly decreased serum cholesterol levels without affecting BP, ankle brachial index, or serum triglyceride levels. The C-reactive protein serum levels decreased significantly in the three statin groups but not in the nonstatin group. These results suggest that long-term use of fluvastatin by hyperlipidaemic hypertensive patients is associated with a significant reduction in aortic stiffness without any effect on BP.
BACKGROUND AND OBJECTIVE: Our objective was to compare the therapeutic compliance in two groups of patients treated with lovastatine for the prevention of cardiovascular diseases in clinical practice. PATIENTS AND METHOD: Observational, prospective and multi-centre study carried out in patients who attended primary care and had a clinical indication to follow treatment with lovastatine for the prevention of cardiovascular diseases. Four visits were carried out (baseline, at 4-6 weeks, at 6 and 12 months). In the baseline visit, clinical and sociodemographic variables were registered. In visit 2, the investigator counted the number of pills the patients had taken, which together with the results of the Morisky Green Questionnaire allowed him to classify the patients into two groups: Group A (non-compliant patient) and B (compliant patient). Group A received medical advice in order to increase the adherence to treatment. RESULTS: A total of 815 subjects with indication of lipid-lowering treatment were involved. At the 6 month of follow up, 22% of the subjects from Group A and 63% from Group B had improved their adherence, 38% of the subjects of the group B maintained a good therapeutic compliance during the whole study and 12% of the group A subjects who came up to the final visit improved their compliance during the whole study (p < 0.05). Subjects who showed good compliance with the lipid-lowering treatment along 12 months registered lesser values of cholesterol (128 mg/dl) (p < 0.005). CONCLUSIONS: It is important to identify non-compliant patients at the beginning of the treatment with lipid-lowering treatment. That makes possible to implement from the very beginning therapeutic measures aimed at improving the therapeutic compliance and allows at the same time to achieve a greater therapeutic effectiveness.
Nonprescriptive factors, including patient adherence, can affect the fluctuations in low-density lipoprotein (LDL) cholesterol observed in the clinical setting. In 241 statin-treated patients, although drugs and doses remained fixed, 57% of patients initially successful in reaching LDL cholesterol targets showed subsequent increases in LDL cholesterol. Conversely, 60% of patients who initially failed to reach targets had subsequent reductions in LDL cholesterol, with nearly 1/3 eventually attaining their LDL cholesterol goals.