Additive beneficial effects of atorvastatin combined with amlodipine in patients with mild-to-moderate hypertension.
BACKGROUND
We hypothesized that atorvastatin combined with amlodipine has additive beneficial vascular and metabolic effects that are superior to monotherapy in patients with hypertension.


METHODS
Forty-two patients were given atorvastatin 20mg/day and placebo, atorvastatin 20mg/day and amlodipine 10mg/day, or amlodipine 10mg/day and placebo during each 2-month treatment period of a randomized, single-blind, placebo-controlled cross-over trial with two 2-month washout periods.


RESULTS
Atorvastatin combined with amlodipine or amlodipine alone significantly reduced blood pressure to a greater extent than atorvastatin alone (all P < 0.001 by ANOVA). Atorvastatin combined with amlodipine significantly reduced plasma malondialdehyde and improved flow-mediated dilation to a greater extent than atorvastatin or amlodipine alone (all P < 0.001 by ANOVA). Atorvastatin therapy significantly increased insulin levels (P = 0.004) and decreased plasma adiponectin levels (P = 0.016) and insulin sensitivity (determined by QUICKI; P = 0.026) relative to baseline measurements. Amlodipine therapy significantly decreased insulin levels (P = 0.001) and increased adiponectin levels (P < 0.001) and insulin sensitivity (P = 0.003) relative to baseline measurements. Atorvastatin combined with amlodipine therapy significantly increased adiponectin levels (P < 0.001) and insulin sensitivity (P = 0.034) relative to baseline measurements. Effects of all three therapeutic arms on adiponectin levels and insulin sensitivity were statistically significant (P < 0.001 by ANOVA).


CONCLUSIONS
Atorvastatin combined with amlodipine therapy improves endothelial function and increases adiponectin levels and insulin sensitivity to a greater extent than monotherapy with either drug in hypertensive patients.
Koh
Kwang Kon
KK
Vascular Medicine and Atherosclerosis Unit Cardiology, Gil Medical Center, Gachon University 1198 Kuwol-dong, Namdong-gu, Incheon 405-760, Republic of Korea. kwangk@gilhospital.com
Quon
Michael J
MJ
Han
Seung Hwan
SH
Lee
Yonghee
Y
Park
Jeong Beom
JB
Kim
Soo Jin
SJ
Koh
Yesl
Y
Shin
Eak Kyun
EK
D017311:Amlodipine / Q000008:administration & dosage*; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D000069059:Atorvastatin; D018592:Cross-Over Studies; D004357:Drug Synergism; D004359:Drug Therapy, Combination; D005260:Female; D006538:Heptanoic Acids / Q000008:administration & dosage*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage*; D006973:Hypertension / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011758:Pyrroles / Q000008:administration & dosage*; D012720:Severity of Illness Index; D016037:Single-Blind Method
D000959:Antihypertensive Agents; D006538:Heptanoic Acids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D011758:Pyrroles; D017311:Amlodipine; D000069059:Atorvastatin