Greater attenuation of blood pressure levels in salt sensitive hypertensive patients after short-term administration of simvastatin

Statins have been reported to improve blood pressure control in essential hypertensive subjects via diverse pathophysiological mechanisms, while salt sensitivity is an emerging cardiovascular risk factor. In this study, we sought to investigate the possible effects of short-term administration of simvastatin on blood pressure levels in salt sensitive and salt resistant essential hypertensive subjects. Eighteen untreated mild essential hypertensive patients (9 men, age 51.2±10.9 years) were screened for salt sensitivity by means of an established protocol. All subjects underwent 24h ambulatory BP monitoring before and after 1 month of treatment with simvastatin (40mg/day). Venous blood samples were drawn before and after statin administration period for determination of lipid, lipoprotein-a, apolipoprotein A1 and apolipoprotein B levels. For the pooled population BMI was 27.2±3.6 kg/m2, left ventricular mass index was 106±35.1 g/m2 and relative wall thickness was 0.45±0.07. Four patients were classified as salt sensitive (SS) (2 men, 60±9 years), while 14 were salt resistant (SR) (7 men, 60±10 years). After 1 month on simvastatin, only SS patients, presented significant reductions in office systolic BP (155±12.9 vs 130±18.2 mmHg, p<0.05), 24-h diastolic BP (85.9±5.7 vs 76.3±4.3 mm Hg, p<0.05), 24-h mean BP (104.4±5.1 vs 93.3±7.5 mm Hg, p<0.05), daytime diastolic BP (89.1±7.6 vs 78.9±6 mm Hg, p<0.05), daytime mean BP (107.5±8.5 vs 95.1±8.3 mm Hg, p<0.05), while patients in the SR group did not exhibit any significant reduction in 24h BP levels (p=NS). Moreover, there was no correlation between the reductions of 24h BP in the SS group and the reductions of the lipid parameters (p=NS). In newly diagnosed essential hypertensive subjects, short-term administration of simvastatin resulted in a significant attenuation of BP values in salt sensitive hypertensives, independently of lipid lowering, suggesting a possible link between salt sensitivity and the pleiotropic mechanisms of statins action. These findings suggest that salt sensitive patients may benefit more from the pleiotropic effects of statins, in the same setting.