Statins, the renin-angiotensin-aldosterone system and hypertension - A tale of another beneficial effect of statins

Abstract

Background: Statins, a class of lipid lowering drugs, decrease mortality associated with cardiovascular events. Ashypercholesterolemia is often accompanied by hypertension, a large number of patients receive therapy with statins andantihypertensive drugs which act via the renin-angiotensin-aldosterone system (RAAS). New guidelines published by theAmerican Heart Association and American College of Cardiology on the treatment of dyslipidaemia and the reduction ofatherosclerotic cardiovascular risk, which use a risk prediction algorithm based on risk factors such as hypertension butnot low-density lipoprotein (LDL) level, may even further increase the number of patients receiving such concomitanttherapy. Method: In this paper we review studies on an interaction between statins, the RAAS and antihypertensive drugs actingvia the RAAS. Result: Accumulating evidence suggests that the combination of statins and drugs affecting the RAAS exerts a synergisticeffect on the circulatory system. For example, statins may lower arterial blood pressure and augment the effect ofantihypertensive drugs acting via the RAAS. Statins may interact with the RAAS in a number of ways i.e. to decrease theexpression of receptors for angiotensin II (Ang II), inhibit the Ang II-dependent intracellular signalling, reduce the RAASdependentoxidative stress and inflammation as well as inhibit the synthesis of Ang II and aldosterone. Conclusion: Although statins given either alone or together with antihypertensive drugs acting via the RAAS may lowerarterial blood pressure, further research is needed to evaluate the mechanisms and their therapeutic significance.