Summary
30 elderly patients (27 male, 3 female) with treated essential hypertension entered a crossover factorial study to determine the effectiveness of pravastatin (10 and 20 mg/day), cholestyramine (4 or 8 g/day) or their combination in the treatment of hypercholesterolaemia (serum cholesterol 5.5 to 7.5 mmol/L). Pravastatin was well tolerated, but significant dose-related adverse effects were observed with cholestyramine (30% with 8 g/day). Both drugs lowered cholesterol and low density lipoprotein (LDL) cholesterol and caused small rises in high density lipoprotein (HDL) cholesterol, leading to improvement in the various calculated ratios. Triglycerides fell with pravastatin but were not altered by cholestyramine. Approximately 75% or more of the total fall in cholesterol was achieved with the lower dose of both drugs. The combination of the 2 drugs was more effective than either drug alone and the combination of the 2 lower doses was more effective than the higher dose of either drug. Thus, this study infers that the use of low doses of the 2 drugs is a more effective way to reduce cholesterol than progressing to higher drug doses.
Similar content being viewed by others
References
Veterans Administration Co-operative Study on Antihypertensive Agents. Effect on mortality in hypertension. 1. Results in patients with diastolic blood pressure ranging from 115–129 mmHg. JAMA 1967; 202: 1028–38
Collins R, Peto R, MacMahon S, et al. Blood pressure, stroke and coronary heart disease. Short-term reductions in blood pressure: overview of randomised drug trials in their epidemiological context. Lancet 1990; 335 (Pt 2): 827–38
Medical Research Council Working Party in Mild to Moderate Hypertension. MRC trial of treatment of mild hypertension: principal results. BMJ 1985; 291: 97–104
MacMahon SW, Norton RN. Alcohol and hypertension: implications for prevention and treatment. Ann Intern Med 1986; 105: 124–5
Reaven GM, Hoffman BB. Hypertension as a disease of carbohydrate and lipoprotein metabolism. Med J Aust 1989; 87Suppl. 6A: 25–65
Lipid Research Clinics Program: The Lipid Research Clinic Coronary Primary Prevention Trial Results. II. The relationship of reduction in incidence of coronary heart disease to cholesterol lowering. JAMA 1984; 251: 365–74
Coronary Drug Project Research Group. The coronary drug project: clofibrate and niacin in coronary heart disease. JAMA 1975; 231: 360–81
Frick MH, Elo O, Haapa K, et al. Helsinki Heart Study: Primary-prevention trial with gemfibrozil in middle-aged men with dyslipidaemia: safety in treatment, changes in risk factors, and incidence of coronary heart disease. N Engl J Med 1987; 317: 1237–45
Scandinavian Simvastatin Survival Study Group. Randomized trial of cholesterol lowering in 4444 patients with coronary heart disease. The Scandinavian Simvastatin Survival Study (4S). Lancet 1994; 344: 1383–9
Brown MS, Goldstein JL. How LDL receptors influence cholesterol and atherosclerosis. Sci Am 1984; 251: 58–66
Brunzell JD, Alberts JJ, Chart A, et al. Plasma lipoproteins in familial combined hypertension and monogenic familial hypertriglyceridaemia. J Lipid Res 1983; 24: 147–55
Grundy SM, Vega GL. Two different views of the relationship of hypertriglyceridaemia to coronary artery disease. Arch Intern Med 1992; 152: 28–34
Shepherd J. Mechanism of action of bile acid sequestrants and other lipid lowering drugs. Cardiology 1989; 76Suppl. 1: 65–74
LaRosa J. Review of clinical studies of bile acid sequestrants for lowering plasma levels. Cardiology 1989; 76Suppl. 1: 55–64
Goldfarb S, Pitot HC. Stimulatory effects of dietary lipids and cholestyramine on hepatic HMG CoA reductase. J Lipid Res 1972; 13: 797–801
Illingworth DR, Sexton GJ. Hypercholesterolemia effects of mevinolin in patients with heterozygous hypercholesterolemia. J Clin Invest 1984; 74: 1972–8
Morgan TO, Anderson A, McDonald P, et al. Simvastatin in the treatment of hypercholesterolemia in patients with essential hypertension. J Hypertens 1990; 8 (1 Suppl.): 25S–32S
Morgan T, Hopper J, Bertram D, et al. A study of the interaction of cholestyramine and simvastatin in the treatment of hypercholesterolemia in elderly hypertensive patients. Cardiol Elderly 1993; 1: 45–50
Cochran WG, Bliss CI. Analysis of variance. In: McArthur J, Colson T, editors. Statistics in Endocrinology. MIT Press, 1967: 33–78
Draper NR, Smith H. Applied regression analysis. New York: Wiley, 1966
Shepherd J, Packard CJ, Patsch JR, et al. Effects of nicotinic acid therapy on plasma high density lipoprotein subfraction distribution and composition on apoprotein A metabolism. J Clin Invest 1969; 63: 858–67
Hunninghake DB, Knopp RH, Schonfeld G, et al. Efficacy and safety of pravastatin in patients with primary hypercholesterolemia. 1: a dose response study. Atherosclerosis 1990; 85: 81–9
McTavish D, Sorkin EM. Pravastatin: a review of its pharmacological properties and therapeutic potential in hypercholesterolemia. Drugs 1991; 41Suppl. 1: 65–9
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Morgan, T.O., Anderson, A., Morgan, O. et al. Effect of Pravastatin, Cholestyramine or their Combination in the Treatment of Hypercholesterolaemia in Elderly Hypertensive Patients. Clin. Drug Invest. 9, 314–323 (1995). https://doi.org/10.2165/00044011-199509060-00002
Published:
Issue Date:
DOI: https://doi.org/10.2165/00044011-199509060-00002