Statins are the most widely prescribed and effective medication for reducing low density lipoprotein cholesterol. Statins may also lower resting blood pressure (BP); however, results are inconsistent. We sought to determine if the maximum dose of atorvastatin reduces resting BP and the peak systolic BP (SBP) achieved on a graded exercise stress test (GEST) among a large sample of 419 healthy men (48%) and women (52%). Subjects (419, ？yr) were double-blinded and randomized to 80？mgd？1 of atorvastatin () or placebo () for 6？mo. Among the total sample, there were no differences in resting BP (SBP, ; diastolic BP [DBP], ; mean arterial pressure (); or peak SBP on a GEST ()) over 6？mo, regardless of drug treatment group. However, among women on atorvastatin, resting SBP/DBP (？mmHg, ？mmHg, ) and peak SBP on a GEST (？mmHg, ) were lower versus men. Atorvastatin lowered resting BP 3-4？mmHg and peak SBP on a GEST ~7？mmHg more among women than men over 6？mo of treatment. The inconsistent findings regarding the antihypertensive effects of statins may be partially explained by not accounting for sex effects. 1. Introduction Statins are the most commonly prescribed and effective medication for reducing low density lipoprotein (LDL) cholesterol and, consequently, lowering cardiovascular disease (CVD) risk . Interestingly, statins may produce other nonlipid, pleiotropic health benefits that may additionally lower CVD risk [2–8]. For example, they may decrease resting blood pressure (BP), which could have a substantial public health impact because hypertension affects one in three U.S. adults and one billion people worldwide [9, 10] and is a major risk factor for heart disease, stroke, congestive heart failure, and kidney disease [11, 12]. Indeed, a recent review has shown that statins lower systolic blood pressure (SBP) up to 8.0？mmHg in patients with dyslipidemia and normal BP; 6.0？mmHg in patients without dyslipidemia and with hypertension; and 13.7？mmHg in patients with dyslipidemia and hypertension . However, other reports have reported no effect of statins on resting BP, and thus results are inconsistent regarding the influence of statin therapy on resting BP [13–15]. These inconsistencies could be attributable to a very small effect of statins on resting BP, such that the benefits of statins on BP may only be apparent during conditions in which BP is augmented, such as exercise. Although a hypertensive response to exercise is predictive of developing future hypertension and increases CVD risk, to the best of our knowledge the effect of statins on the peak
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