Comparative efficacy of fixed-dose statin and antihypertensive agent combinations: A network meta-analysis of randomized controlled trials

• Published in: Vascular pharmacology 2021-12, Vol.141, p.106900-106900, Article 106900
• Main Authors: Bellos, Ioannis, Pergialiotis, Vasilios, Perrea, Despina N.
• Format: Article
• Language: English
• Subjects: Antihypertensive Agents - therapeutic use; Antihypertensives; Blood Pressure; Cholesterol; Clinical trials; Confidence intervals; Density; Dosage; Drug Combinations; Dyslipidemia; Fixed-dose; High density lipoprotein; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; Hypertension; Hypertension - chemically induced; Hypertension - diagnosis; Hypertension - drug therapy; Lipid-lowering; Lipids; Meta-analysis; Network Meta-Analysis; Polypill; Pressure effects; Randomized Controlled Trials as Topic; Reagents; Reduction; Serum lipids; Statins; Triglycerides
• ISSN: 1537-1891; 1879-3649
• DOI: 10.1016/j.vph.2021.106900

The concurrent administration of statins and antihypertensive agents has been associated with improved cardiovascular outcomes, although the optimal fixed-dose combination remains unclear. This meta-analysis aims to compare the blood pressure and lipid-lowering effects of various statin and antihypertensive drug combinations. PubMed, Scopus, Web of Science, CENTRAL and Clinicaltrials.gov were systematically searched from inception to 20 March 2021. Randomized controlled trials evaluating the effects of statin-antihypertensive agent combinations on systolic blood pressure or serum lipids were held eligible. A random-effects frequentist model was applied to provide estimates of mean difference of percentage change. Overall, 18 studies were included, comprising 4450 patients. Compared to statin monotherapy no significant difference in the percentage change of low-density lipoprotein cholesterol was achieved by adding any antihypertensive agent. Compared to amlodipine monotherapy, the addition of moderate-intensity statin resulted in a significantly greater percentage reduction of systolic blood pressure (−2.22%, 95% confidence intervals: [−3.82 to −0.62]). Combined high-intensity statin and amlodipine lead to significant increase of high-density lipoprotein cholesterol (8.34%, 95% confidence intervals: [0.73 to 15.95]), while effective triglyceride reduction was achieved by adding amlodipine and telmisartan to high-intensity statin (−14.68%, 95% confidence intervals: [−28.48 to −0.89]). No significant difference of adverse effects was observed. The present network meta-analysis suggests that the administration of fixed-dose combinations of statins and antihypertensive agents is safe and effective in reducing blood pressure and serum lipids. The optimal dosing strategy to prevent cardiovascular events remains to be determined. [Display omitted] •Adding antihypertensive drugs to statin therapy does not hinder its efficacy.•The statin-amlodipine combination achieved greater systolic blood pressure decrease.•Combined statin and amlodipine ranked highest regarding HDL-C elevation.•Adding amlodipine with or without telmisartan achieved greater triglyceride change.•The combined statin-antihypertensive therapy was equally safe to monotherapy.