《Hypertension》.pdfVIP

Hypertension Impact of Statin Therapy on Central Aortic Pressures and Hemodynamics Principal Results of the Conduit Artery Function Evaluation–Lipid- Lowering Arm (CAFE-LLA) Study Bryan Williams, MD, FRCP; Peter S. Lacy, PhD; J. Kennedy Cruickshank, MD, FRCP; David Collier, MBBS, PhD; Alun D. Hughes, MBBS, PhD; Alice Stanton, PhD, FRCPI; Simon Thom, MD, FRCP; Herbert Thurston, MD, FRCP; for the CAFE and ASCOT Investigators Background—Statins reduce the risk of cardiovascular events in people with hypertension. This benefit could arise from a beneficial effect of statins on central aortic pressures and hemodynamics. The Conduit Artery Function Evaluation– Lipid-Lowering Arm (CAFE-LLA) study, an Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) substudy, investigated this hypothesis in a prospective placebo-controlled study of treated patients with hypertension. Methods and Results—CAFE-LLA recruited 891 patients randomized to atorvastatin 10 mg/d or placebo from 5 centers in the United Kingdom and Ireland. Radial artery applanation tonometry and pulse-wave analysis were used to derive central aortic pressures and hemodynamic indices at repeated visits over 3.5 years of follow-up. Atorvastatin lowered low-density lipoprotein cholesterol by 32.4 mg/dL (95% confidence interval [CI], 28.6 to 36.3) and total cholesterol by 35.1 mg/dL (95% confidence interval, 30.9 to 39.4) relative to placebo. Time-averaged brachial blood pressure was similar in CAFE-LLA patients randomized to atorvastatin or placebo (change in brachial systolic blood pressure, 0.1 mm Hg [95% CI, 1.8 to 1.6], P 0.9; change in brachial pulse pressure, 0.02 mm Hg [95% CI, 1.6 to 1.6], P 0.9).