“The take-home message is that statins are safe and effective, and that because benefits were similar irrespective of pretreatment cholesterol levels or levels of inflammatory markers, no baseline blood tests are required to identify the patients who will derive benefits from this treatment,” said Jackie Bosch, Ph.D., associate professor of rehabilitation science at McMaster University and director of the prevention Program at the Population Health Research Institute, who led the report focused on rosuvastatin. “Our results were remarkably consistent across all subgroups.”

An analysis focusing on the use of blood pressure lowering drugs alone revealed no significant improvements overall in those receiving the drugs compared with those receiving a placebo. However, in a pre-specified analysis, when the patients were stratified into thirds by baseline systolic blood pressure, an analysis of subgroups with the highest, middle and lowest starting systolic blood pressure revealed significant differences. Among the one-third of participants with the highest blood pressure, a starting systolic blood pressure above 143.5 mm Hg, 4.8 percent experienced the first co-primary endpoint and 5.7 percent experienced the second co-primary endpoint, significantly lower than 6.5 and 7.5 percent, respectively, among patients taking placebo.


“Overall in this population the blood pressure lowering drugs had no clear benefit, but in those with higher blood pressure before therapy—over 143.5 mm Hg—the treatment was effective. However, there was no benefit in those with lower blood pressure and even a tendency towards harm in those in the lowest third of the blood pressure distribution,” said Eva Lonn, M.D., FACC, a cardiologist and professor of cardiology at McMaster University and senior scientist at the Population Health Research Institute, who led the report focused on blood pressure lowering medications. “These data suggest blood pressure-lowering medications are appropriate for people with hypertension but that people with lower blood pressure who have no other reasons to use blood pressure reducing drugs should avoid taking these drugs.”

Treating high blood pressure can be a time-consuming and intensive process involving multiple visits to the doctor’s office for blood tests to help adjust dosing. This itself has been a significant impediment to reducing risk in people with hypertension because many patients find it inconvenient to make multiple visits or use multiple drugs, especially at full doses, which carries a higher risk of side-effects. Yusuf said the study findings point to the value of a more simplified approach, which places more emphasis on statins in the general population and adds low doses of combination blood pressure medications to the statins in patients with mild hypertension. In this study, combination therapy reduced risk among people with elevated blood pressure by 40 percent safely, without dose titration or the need for frequent blood tests.

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