title: Impact of Xuezhikang on coronary events in hypertensive patients with previous myocardial infarction from the China Coronary Secondary Prevention Study (CCSPS) Pravastatin for Cardiovascular Event Primary Prevention in Patients With Mild-to-Moderate Hypertension in the Management of Elevated Cholesterol in the Primary Prevention Group of Adult Japanese (MEGA) Study Effects of combined therapy of Xuezhikang Capsule (血脂康胶囊) and Valsartan on hypertensive left ventricular hypertrophy and heart rate turbulence Prevention of Coronary and Stroke Events with Atorvastatin in Hypertensive Patients who have Average or Lower-than-Average Cholesterol Concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial— Lipid Lowering Arm (ASCOT-LLA): A Multicentre Randomised Controlled Trial Cholesterol-lowering effects of a proprietary Chinese red-yeast-rice dietary supplement. Reduction in blood pressure with statins: results from the UCSD Statin Study, a randomized trial. Prospective evaluation of the effect of statins on blood pressure control in hypertensive patients in clinical practice. Lipid lowering in patients with treatment-resistant hypertension: an analysis from the Treating to New Targets (TNT) trial. [The effect of Xuezhikang on ventricular diastolic function in hypertension]. Xuezhikang, an Extract of Cholestin, Protects Endothelial Function Through Antiinflammatory and Lipid-Lowering Mechanisms in Patients With Coronary Heart Disease Xuezhikang decreases serum lipoprotein(a) and C-reactive protein concentrations in patients with coronary heart disease. Red yeast rice lowers cholesterol in physicians - a double blind, placebo controlled randomized trial Statins, antihypertensive treatment, and blood pressure control in clinic and over 24 hours: evidence from PHYLLIS randomised double blind trial Outcome Measures of Chinese Herbal Medicine for Hypertension: An Overview of Systematic Reviews Effect of xuezhikang, a cholestin extract, on reflecting postprandial triglyceridemia after a high-fat meal in patients with coronary heart disease. Pravastatin decreases blood pressure in hypertensive and hypercholesterolemic patients receiving antihypertensive treatment. Effect of xuezhikang on cardiovascular events and mortality in elderly patients with a history of myocardial infarction: a subgroup analysis of elderly subjects from the China Coronary Secondary Prevention Study. Long-Term Effects of Xuezhikang on Blood Pressure in Hypertensive Patients with Previous Myocardial Infarction: Data from the Chinese Coronary Secondary Prevention Study (CCSPS) Beneficial impact of Xuezhikang on cardiovascular events and mortality in elderly hypertensive patients with previous myocardial infarction from the China Coronary Secondary Prevention Study (CCSPS). Effects of Xuezhikang (血脂康) and pravastatin on circulating endothelial progenitor cells in patients with essential hypertension Xuezhikang, An Extract of Cholestin, Reduces Cardiovascular Events in Type 2 Diabetes Patients With Coronary Heart Disease: Subgroup Analysis of Patients With Type 2 Diabetes From China Coronary Secondary Prevention Study (CCSPS) Potential protective effect of long-term therapy with Xuezhikang on left ventricular diastolic function in patients with essential hypertension. Association between different lipid-lowering treatment strategies and blood pressure control in the Brisighella Heart Study. Pravastatin has an additional depressor effect in patients undergoing long-term treatment with antihypertensive drugs. C-reactive protein and the risk of developing hypertension. Major outcomes in moderately hypercholesterolemic, hypertensive patients randomized to pravastatin vs usual care: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT-LLT). [The beneficial effects of xuezhikang on top of extended-released nifedipine in hypertensive patients without severe hyperlipidemia]. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). C-reactive protein (CRP) gene polymorphisms, CRP levels and risk of incident essential hypertension: findings from an observational cohort of Han Chinese
abstract: Abstract Background . The lowering of cholesterol concentrations in individuals at high risk for cardiovascular disease improves clinical outcome . Xuezhikang has a marked impact on lipids . Methods . In this r and omized , double-blinded , placebo-controlled , parallel-group clinical trial , a total of 2704 hypertensive patients with previous myocardial infa rct ion ( MI ) were assigned either to placebo ( n = 1341 ) or to Xuezhikang ( 0.6 g twice daily , n = 1363 ) for an average of 4.5 years . The primary end-point was recurrent coronary events ; the secondary end-point was all-cause mortality and other clinical events , including adverse effects . Results . There were no differences between the Xuezhikang and placebo group in base-line characteristics . However , Xuezhikang treatment reduced the incidence of coronary events by 43.0 % ( P = 0.02 ) , deaths from coronary heart disease ( CHD ) by 30.0 % ( P < 0.01 ) , and all-cause mortality by 35.8 % ( P = 0.001 ) . Conclusions . This study , for the first time , demonstrated that long-term Xuezhikang therapy result ed in significant reduction in cardiovascular events and death in Chinese hypertensive patients with previous MI in a safe manner Lipid-lowering therapy in individuals with high risk of cardiovascular disease reduces the incidence of coronary heart disease . However , few studies have assessed the benefits of cholesterol lowering for primary prevention of coronary heart disease in hypertensive patients with mild dyslipidemia or without conventional dyslipidemia . The large , r and omized Management of Elevated Cholesterol in the Primary Prevention Group of Adult Japanese Study showed a 33 % reduction in coronary heart disease incidence with pravastatin as the primary prevention in Japanese patients . We conducted an exploratory analysis of the effect of diet plus pravastatin therapy on the primary prevention of cardiovascular events ( coronary heart disease , coronary heart disease plus cerebral infa rct ion , and cardiovascular disease ) in the 3277 patients with hypertension during the 5-year follow-up . There were no significant differences in mean baseline total cholesterol , blood pressure levels , or variation in blood pressure during the 5-year period between the diet ( n=1664 ) and diet plus pravastatin ( n=1613 ) groups . In the diet plus pravastatin group , the relative risk of coronary heart disease plus cerebral infa rct ion was reduced by 35 % ( hazard ratio : 0.65 ; CI : 0.46 to 0.93 ; P=0.02 ) , cerebral infa rct ion by 46 % ( hazard ratio : 0.54 ; CI : 0.29 to 0.98 ; P=0.04 ) , and cardiovascular disease by 33 % ( hazard ratio : 0.67 ; CI : 0.49 to 0.91 ; P=0.01 ) . In patients without a history of cardiovascular disease who have hypertension and mildly elevated cholesterol , pravastatin was effective in reducing the incidence of cardiovascular disease , particularly cerebral infa rct ion . Hence , in patients with hypertension with mildly elevated cholesterol levels , treatment with a statin is advisable to reduce the burden of cardiovascular disease Objective To observe the effect of combined therapy with Xuezhikang Capsule ( 血脂康胶囊 , XZK ) and Valsartan on left ventricular hypertrophy ( LVH ) and heart rate turbulence ( HRT ) in hypertensive patients . Methods Ninety primary hypertensive patients with LVH were r and omly assigned to three groups . Basic treatment , including aspirin , β-blockers , calcium antagonists , etc . were administered to all patients . Additionally , Valsartan ( VS , 80 mg once a day ) was given to the 30 patients in the VS group . Valsartan ( in the same dosage ) and XZK ( 600 mg , twice a day ) were given to the 32 patients in the Chinese medicine ( CM ) group , while none was given to the 28 patients in the control group . The therapeutic course lasted for 24 months . Changes in left ventricular mass index ( LVMI ) measured by cardiac ultrasonic indices , HRT parameters , including the original heart rate ( TO ) and slope coeffificient ( TS ) , systolic and diastolic blood pressures ( SBP and DBP ) , as well as blood cholesterol level ( TC ) were measured before and after treatment . Results After treatment , TO and LVMI were lowered , while TS increased in both the VS group and the CM group ( P<0.01 ) , but changed insignificantly in the control group . Significant differences between the CM group and the control group were shown in terms of TO , LVMI , SBP , DBP and TS ( P<0.01 ) ; and between the CM group and the VS group in terms of TO , LVMI and TS ( P<0.01 ) . Moreover , HRT parameters showed an evident correlation with LVMI ( r=0.519–0.635 , P<0.01 ) . Conclusion Combined therapy with XZK and Valsartan can improve hypertensive LVH and HRT parameters , and lessen the damage on the autonomous nervous system Summary Background The lowering of cholesterol concentrations in individuals at high risk of cardiovascular disease improves outcome . No study , however , has assessed benefits of cholesterol lowering in the primary prevention of coronary heart disease ( CHD ) in hypertensive patients who are not conventionally deemed dyslipidaemic . Methods Of 19 342 hypertensive patients ( aged 40–79 years with at least three other cardiovascular risk factors ) r and omised to one of two antihypertensive regimens in the Anglo-Sc and inavian Cardiac Outcomes Trial , 10 305 with nonfasting total cholesterol concentrations 6.5 mmol/L or less were r and omly assigned additional atorvastatin 10 mg or placebo .  These patients formed the lipid-lowering arm of the study . We planned follow-up for an average of 5 years , the primary endpoint being non-fatal myocardial infa rct ion and fatal CHD . Data were analysed by intention to treat . Findings Treatment was stopped after a median follow-up of 3.3 years . By that time , 100 primary events had occurred in the atorvastatin group compared with 154 events in the placebo group ( hazard ratio 0.64 [ 95 % CI 0.50–0.83 ] , p = 0.0005 ) . This benefit emerged in the first year of follow-up . There was no significant heterogeneity among prespecified subgroups . Fatal and non-fatal stroke ( 89 atorvastatin vs 121 placebo , 0.73 [ 0.56–0.96 ] , p = 0.024 ) , total cardiovascular events ( 389 vs 486 , 0.79 [ 0.69–0.90 ] , p = 0.0005 ) , and total coronary events ( 178 vs 247 , 0.71 [ 0.59–0.86 ] , p = 0.0005 ) were also significantly lowered . There were 185 deaths in the atorvastatin group and 212 in the placebo group ( 0.87 [ 0.71–1.06 ] , p = 0.16 ) . Atorvastatin  lowered total serum cholesterol by about 1.3 mmol/L compared with placebo at 12 months , and by 1.1 mmol/L after 3 years of follow-up . Interpretation The reductions in major cardiovascular events with atorvastatin are large , given the short follow-up time . These findings may have implication s for future lipid-lowering guidelines BACKGROUND We examined the cholesterol-lowering effects of a proprietary Chinese red-yeast-rice supplement in an American population consuming a diet similar to the American Heart Association Step I diet using a double-blind , placebo-controlled , prospect ively r and omized 12-wk controlled trial at a university research center . OBJECTIVE We evaluated the lipid-lowering effects of this red-yeast-rice dietary supplement in US adults separate from effects of diet alone . DESIGN Eighty-three healthy subjects ( 46 men and 37 women aged 34 - 78 y ) with hyperlipidemia [ total cholesterol , 5.28 - 8.74 mmol/L ( 204 - 338 mg/dL ) ; LDL cholesterol , 3.31 - 7.16 mmol/L ( 128 - 277 mg/dL ) ; triacylglycerol , 0.62 - 2.78 mmol/L ( 55 - 246 mg/dL ) ; and HDL cholesterol 0.78 - 2.46 mmol/L ( 30 - 95 mg/dL ) ] who were not being treated with lipid-lowering drugs participated . Subjects were treated with red yeast rice ( 2.4 g/d ) or placebo and instructed to consume a diet providing 30 % of energy from fat , < 10 % from saturated fat , and < 300 mg cholesterol daily . Main outcome measures were total cholesterol , total triacylglycerol , and HDL and LDL cholesterol measured at weeks 8 , 9 , 11 , and 12 . RESULTS Total cholesterol concentrations decreased significantly between baseline and 8 wk in the red-yeast-rice-treated group compared with the placebo-treated group [ ( x+/-SD ) 6.57+/-0.93 mmol/L ( 254+/-36 mg/dL ) to 5.38+/-0.80 mmol/L ( 208+/-31 mg/dL ) ; P < 0.001 ] . LDL cholesterol and total triacylglycerol were also reduced with the supplement . HDL cholesterol did not change significantly . CONCLUSIONS Red yeast rice significantly reduces total cholesterol , LDL cholesterol , and total triacylglycerol concentrations compared with placebo and provides a new , novel , food-based approach to lowering cholesterol in the general population BACKGROUND Some studies have suggested reductions in blood pressure (BP)with statin treatment , particularly in persons with hypertension . R and omized trial evidence is limited . METHODS We performed a r and omized , double-blind , placebo-controlled trial with equal allocation to simvastatin , 20 mg ; pravastatin sodium,40 mg ; or placebo for 6 months . Nine hundred seventy-three men and women without known cardiovascular disease or diabetes mellitus , with low-density lipoprotein cholesterol screening levels of 115 to 190 mg/dL , had assessment of systolic and diastolic BP ( SBP and DBP , respectively ) .  Blood pressure values were compared for placebo vs statins by intention-to-treat ( ITT ) analysis . Additional analyses were performed that ( 1 ) were confined to subjects with neither high baseline BP ( SBP>140 mm Hg or DBP>90 mm Hg ) nor receiving BP medications , to exclude groups in whom BP medications or medication changes may have influenced results , and ( 2 ) separately evaluated simvastatin and pravastatin ( vs placebo ) . The time course of BP changes after statin initiation and the effect of stopping statins on BP were examined . RESULTS Statins modestly but significantly reduced BP relative to placebo , by 2.2 mm Hg for SBP ( P=.02 ) and 2.4 mm Hg for DBP ( P<.001 ) in ITT analysis . Blood pressure reductions ranged from 2.4 to 2.8 mm Hg for both SBP and DBP with both simvastatin and pravastatin , in those subjects with full follow-up , and without potential for influence by BP medications ( ie , neither receiving nor meriting BP medications ) . CONCLUSIONS Reductions in SBP and DBP occurred with hydrophilic and lipophilic statins and extended to normotensive subjects . These modest effects may contribute to the reduced risk of stroke and cardiovascular events reported on statins . Trial Registration clinical trials.gov Identifier : NCT00330980 BACKGROUND AND AIM Some clinical evidence supports a statin antihypertensive effect . Our aim is to evaluate the statin effect on blood pressure control in hypertensive patients in the setting of clinical practice , and the role of some predetermined individual patient characteristics ( age , gender , baseline BP levels , pre-treatment LDL-C levels ) on the supposed statin BP lowering effect . METHODS AND RESULTS Two hundred and fifty-four hypertensive patients with hypercholesterolemia were enrolled in the Ambulatory service of the Hypertension Research Unit of Bologna University Hospital . After 2 - 4 weeks of a run-in period patients were allocated to statin treatment and followed-up for 24 weeks . The blood pressure response to statins was compared in several subgroups of patients according to age , gender , baseline BP and pre-treatment cholesterolemia . In the overall study population , the use of statins was associated with a significant reduction in systolic ( -7.6+/-4 mmHg , p<0.05 ) and diastolic blood pressures ( -5.2+/-3 mmHg , p<0.05 ) in comparison to baseline . The blood pressure decrease was more pronounced in patients younger than 65 years ( p<0.05 ) , with higher baseline systolic blood pressure ( p<0.005 ) , and in those with higher cholesterolemia before statins ( p<0.05 ) . CONCLUSIONS Our study suggests a BP-lowering effect of statins , consistent with some other literature . Some parameters like age , baseline systolic blood pressure and cholesterolemia influence the antihypertensive effect of statins . The lack of consideration for these confounding factors may be one of the reasons for the conflicting results about the BP lowering effects of statins AIM Patients with resistant hypertension are at high risk for adverse cardiovascular events . Efforts have been focused on lowering the surrogate endpoint of blood pressure ( BP ) with scant focus on reduction of hard cardiovascular endpoints . However , whether or not intensive lipid lowering is beneficial for reducing the risk of cardiovascular events in this high-risk cohort is not known . METHODS AND RESULTS We evaluated 10 001 patients with coronary artery disease and a low-density lipoprotein cholesterol level < 130 mg/dL , r and omized to atorvastatin 80 vs. 10 mg , enrolled in the Treating to New Targets trial . Treatment-resistant hypertension ( TRH ) was defined as BP ≥140 mmHg despite being on three antihypertensive agents or < 140 mmHg on four or more agents . Subjects were followed up for a median duration of 4.9 years . The primary outcome was major cardiovascular events ( composite of non-fatal myocardial infa rct ion ( MI ) , fatal coronary heart disease ( CHD ) , resuscitated cardiac arrest , and stroke ) . Among the 10 001 patients in the trial , 1112 ( 11.1 % ) patients had TRH . Atorvastatin 80 mg , in patients with TRH , was associated with a significant reduction in the risk of the primary outcome ( HR = 0.70 ; 95 % CI 0.52 - 0.93 ; P = 0.01 ) , driven largely by a significant reduction in CHD deaths ( HR = 0.55 ; 95 % CI 0.32 - 0.97 ; P = 0.04 ) . In addition , atorvastatin 80 mg was associated with a reduction in major coronary events ( HR = 0.67 ; 95 % CI 0.49 - 0.93 ; P = 0.02 ) , and any cardiovascular or coronary event and with a trend ( P = 0.05 ) towards reduction in all-cause mortality ( HR = 0.68 ; 95 % CI 0.46 - 1.01 ) when compared with atorvastatin 10 mg . The results were similar when analysed for the two separate components of the TRH cohort . CONCLUSION In subjects with TRH , intensive lipid lowering with atorvastatin 80 mg is associated with a significant reduction in cardiovascular events OBJECTIVE To investigate whether statins have effect on diastolic function of both left and right ventricles in hypertensive patients . METHODS This is a r and omized , mono-blind , placebo-controlled study . 120 systemic hypertensive ( HT ) patients with normal or slightly elevated cholesterol were r and omized to placebo or Xuezhikang ( 1200 mg/d ) for 24 weeks . Extended-release nifedipine was administrated to the HT patients . 30 healthy volunteers served as controls . Plasma were obtained at baseline and 24 weeks after Xuezhikang therapy .  Cholesterol and carboxy-terminal peptide of procollagen type I ( PIP ) were measured . Early diastolic velocity ( Em ) and late diastolic velocity ( Am ) were obtained from right atrioventricular ring and left atrioventricular ring with pulsed wave tissue Doppler imaging . RESULTS The levels of plasma PIP were higher in HT patients . After 24 weeks , the levels of plasma LDL-C , TC and PIP were significantly lower in Xuezhikang group than those in placebo group ; Systolic and diastolic pressure were decreased both in placebo group and Xuezhikang group meanwhile pulse pressure was decreased and Em/Am ratio at left atrioventricular ring was higher in Xuezhikang group as compared with those in placebo group . CONCLUSION In systemic hypertensive patients , Xuezhikang exerts a beneficial effect on diastolic function of left ventricule via controlling blood pressure , lowering blood lipid and inhibiting myocardial fibrosis Background —Endothelial dysfunction is associated with inflammation and postpr and ial hypertriglyceridemia . Xuezhikang , an extract of Cholestin , a dietary supplement , has lipid-modulating and antiinflammatory effects . We explored the effects of xuezhikang on endothelial function and high-sensitivity C-reactive protein ( hs-CRP ) in patients with coronary heart disease ( CHD ) . Methods and Results —We prospect ively r and omized 50 CHD patients to xuezhikang 1200 mg/d or placebo for 6 weeks .  Fasting hs-CRP concentrations , flow-mediated vasodilation ( FMD ) at 0 and 4 hours , and lipid parameters at 0 , 2 , 4 , and 6 hours were monitored after a high-fat meal ( 800 calories ; 50 g fat ) in all patients . All patients underwent a high-fat meal test at the beginning of the study and after 6 weeks of treatment . Postpr and ial FMD was significantly worse at 4 hours after a high-fat meal ( P<0.05 ) , and this was associated with the area under the triglyceride curve ( TG-AUC ) ( r=0.345 , P<0.01 ) . After 6 weeks of xuezhikang , fasting hs-CRP levels and TG-AUC ( P<0.001 for each ) decreased . Furthermore , prepr and ial and postpr and ial FMD significantly improved ( P<0.001 ) . There were no significant changes in serum lipids and FMD in the placebo arm . In multivariable regression analysis , changes in TG-AUC and fasting hs-CRP levels were predictive of improvement in prepr and ial FMD ( P<0.05 ) . Conclusions —Xuezhikang effectively improved prepr and ial and postpr and ial endothelial function through its potent antiinflammatory and lipid-lowering effects BACKGROUND Increased serum lipoprotein(a ) [ Lp(a ) ] and high-sensitivity C-reactive protein ( hsCRP ) concentrations are independent risk factors for coronary heart disease ( CHD ) . Xuezhikang , an extract of cholestin , effectively lowers fasting cholesterol and triglyceride concentrations . We studied whether xuezhikang lowered Lp(a ) and hsCRP concentrations . METHODS We r and omly divided 60 CHD patients into two groups to receive xuezhikang ( 1200 mg daily ) or placebo for 6 weeks . The fasting hsCRP concentration and the postpr and ial changes of serum lipid concentrations at 2 , 4 , and 6 h after a high-fat meal ( 800 calories ; 50 g of fat ) were measured before and after the 6-week protocol . RESULTS The two groups had similar baseline fasting lipid and hsCRP concentrations . The postpr and ial triglyceride and Lp(a ) concentrations were significantly increased ( P < 0.05 ) . After 6 weeks , the fasting and postpr and ial lipid concentrations decreased significantly in the xuezhikang group , accompanied by a significant reduction in fasting hsCRP concentration ( P < 0.001 ) . The placebo group had no significant change in lipid concentrations , whereas the fasting serum hsCRP concentration was reduced significantly ( P < 0.05 ) . The reduction in hsCRP was closely related to the changes in fasting Lp(a ) concentration ( r = 0.402 ; P < 0.05 ) and triglyceride area under the curve ( r = 0.441 ; P < 0.001 ) . CONCLUSIONS Xuezhikang effectively decreased fasting Lp(a ) and postpr and ial triglyceride concentrations , which were associated with reductions of fasting hsCRP concentrations in CHD patients Background In recent years , red yeast rice ( RYR ) supplements have been marketed aggressively as a natural way to lower cholesterol ; however , the large majority of commercially available products have not been studied according to current research st and ards . Methods In a double blind placebo controlled r and omized trial , 52 physicians and their spouses with a total cholesterol level of > 200 mg/dL were r and omly allocated to receive a RYR extract or placebo for 8 weeks . As a primary outcome measure , we compared the before-after difference in lipid levels between both groups . As secondary outcome measures we looked at side-effects , CK elevation and a change in cardiovascular risk . Results LDL ( low density lipoprotein ) cholesterol was lowered with 36 mg/dL ( 22 % ) and total cholesterol with 37 mg/dL ( 15 % ) in the intervention group . This result was statistically significant as compared to the control group , in which no reduction in total cholesterol and LDL was observed ( p < 0.001 ) . There was no marked difference in CK ( creatine kinase)-elevation or reported side-effects between study groups . In 5/31 participants in the intervention group , the lipid lowering effect result ed in lower cardiovascular risk as measured with SCORE ( Systematic COronary Risk Evaluation ) . Conclusions The RYR formulation under study was effective in lowering cholesterol and LDL cholesterol in this study population . RYR therapy may be an attractive and relatively well studied alternative in patients who are intolerant for statins or who have objections against pharmacological lipid lowering . However , consumers need to be warned that the actual content of commercially available preparations is not assured by governmental regulations , which raises effectiveness and safety issues . Trial registration Clinical trials.gov , nr : Objective To investigate the possibility that statins reduce blood pressure as well as cholesterol concentrations through clinic and 24 hour ambulatory blood pressure monitoring . Design R and omised placebo controlled double blind trial . Setting 13 hospitals in Italy Participants 508 patients with mild hypertension and hypercholesterolaemia , aged 45 to 70 years . Intervention Participants were r and omised to antihypertensive treatment ( hydrochlorothiazide 25 mg once daily or fosinopril 20 mg once daily ) with or without the addition of a statin ( pravastatin 40 mg once daily ) . Main outcome measures Clinic and ambulatory blood pressure measured every year throughout an average 2.6 year treatment period . Results Both the group receiving antihypertensive treatment without pravastatin ( n=254 ) ( with little change in total cholesterol ) and the group receiving antihypertensive treatment with pravastatin ( n=253 ) ( with marked and sustained reduction in total cholesterol and low density lipoprotein cholesterol ) had a clear cut sustained reduction in clinic measured systolic and diastolic blood pressure as well as in 24 hour , and day and night , systolic and diastolic blood pressure .  Pravastatin performed slightly worse than placebo , and between group differences did not exceed 1.9 ( 95 % confidence interval −0.6 to 4.3 , P=0.13 ) mm Hg throughout the treatment period . This was also the case when participants who remained on monotherapy with hydrochlorothiazide or fosinopril throughout the study were considered separately . Conclusions Administration of a statin in hypertensive patients in whom blood pressure is effectively reduced by concomitant antihypertensive treatment does not have an additional blood pressure lowering effect . Trial registration BRISQUI_*IV_2004_001 ( registered at Osservatorio Nazionale sulla Sperimentazione Clinica dei Medicinali — National Monitoring Centre on Clinical Research with Medicines ) Objective . The aim of this overview was to summarize the outcome measures of Chinese herbal medicine ( CHM ) for the treatment of hypertension based on available systematic review s ( SRs ) , so as to evaluate the potential benefits and advantages of CHM on hypertension . Methods . Literature search es were conducted in the Cochrane Data base of Systematic Review s , MEDLINE , and 4 data bases in Chinese . SRs of CHM for hypertension were included . Two independent review ers ( J. Wang and X. J. Xiong ) extracted the data . Results . 10 SRs were included . 2 SRs had primary endpoints , while others focused on secondary endpoints to evaluate CHM for hypertension such as blood pressure ( BP ) and Traditional Chinese Medicine ( TCM ) syndrome . 6 SRs have reported the adverse effects , whereas the other 4 SRs have not mentioned it at all . Many CHM appeared to have significant effect on improving BP , TCM syndrome , and so on . However , most SRs failed to make a definite conclusion for the effectiveness of CHM for hypertension due to poor evidence . Conclusion . Primary endpoints have not been widely used currently . The benefits of CHM for hypertension need to be confirmed in the future with r and omized controlled trials ( RCTs ) of more persuasive primary endpoints and high- quality SRs The effect of xuezhikang on postpr and ial triglyceride ( TG ) level was investigated in patients with coronary heart disease ( CHD ) after a high-fat meal ( 800 cal ; 50 g fat ) . Fifty CHD patients were r and omly divided into two groups to accept xuezhikang ( xuezhikang group ) 1200 mg/day ( 600 mg twice daily ) or not ( control group ) on the base of routine therapy which included aspirin , metoprolol and fosinopril and nitrates during the whole 6 weeks following-up . Xuezhikang significantly reduced fasting serum total cholesterol ( TC ) ( -20 % ) , low-density lipoprotein cholesterol ( LDL-C , -34 % ) , TG ( -32 % ) and apoB ( -27 % ) levels , and raised fasting high-density lipoprotein cholesterol ( HDL-C , 18 % ) and apoA-I ( 13 % ) levels ( P<0.001 ) . The postpr and ial serum TG levels at 2 , 4 and 6 h decreased 32 , 38 and 43 % , respectively , in xuezhikang group ( P<0.001 ) . The TG area under the curve over the fasting TG level ( TG-AUC ) significantly decreased in CHD patients accepted xuezhikang with normal ( less than 1.7 mmol/l ) and elevated ( 1.74 to 2.92 mmol/l ) fasting TG levels by 45 and 50 % , respectively ( P<0.001 ) . Routine therapy had no significant effect on the fasting and postpr and ial lipid and apolipoprotein levels . The change of TG-AUC was significantly related to the changes of fasting TG , TC , LDL-C , and HDL-C levels after the treatment , which were related to the changes of fasting apoA-I and apoB levels significantly ( P<0.001 ) . Xuezhikang was shown to be beneficial in the treatment of reflecting postpr and ial triglyceridemia in CHD patients with normal and mildly elevated fasting TG levels BACKGROUND Previous studies have suggested that the lipid-lowering agents , statins , may help reduce blood pressure ( BP ) . The goal of the present study was to characterize the effect of pravastatin on BP in hypercholesterolemic and hypertensive patients already receiving antihypertensive drugs . METHODS AND RESULTS Eighty-two patients with hypercholesterolemia were retrospectively studied before and after 3 months of treatment with pravastatin .  Forty-four patients had hypertension ( HT group ) and were receiving antihypertensive treatment , while the remaining 38 patients were normotensive ( NT group ) . Patients in the HT group were further subdivided into those with uncontrolled or controlled BP . Pravastatin treatment significantly reduced systolic BP ( SBP ) in the HT group ( 134+/-16 to 130+/-13 mmHg , p<0.005 ) but not in the NT group ( 124+/-10 to 123+/-9 mmHg , p=0.52 ) , despite the fact that treatment significantly reduced low-density lipoprotein cholesterol in both groups ( HT group 178+/-27 to 132+/-17 mg/dl , p<0.0001 ; NT group 169+/-27 to 125+/-21 mg/dl , p<0.0001 ) . Further , pravastatin significantly decreased SBP in the uncontrolled BP group ( 148+/-7 to 138+/-12 mmHg , p<0.005 ) but not in the controlled BP group ( 122+/-10 to 123+/-9 mmHg , p=0.72 ) . CONCLUSION Concomitant use of statins and antihypertensive drugs could result in improved BP control in hypertensive patients with hypercholesterolemia OBJECTIVES To evaluate whether lipid-lowering therapy with xuezhikang reduces the risk of coronary events and total mortality in patients with coronary heart disease ( CHD ) aged 65 and older . DESIGN Subgroup analysis of the China Coronary Secondary Prevention Study , a r and omized , double-blind , placebo-controlled , clinical trial . SETTING Sixty-six hospitals in China . PARTICIPANTS A total of 1,445 patients , aged 65 to 75 , were chosen from 4,780 patients with a history of myocardial infa rct ion . INTERVENTION The patients were r and omized to the xuezhikang ( n=735 ) or the placebo ( n=710 ) group and followed for a mean of 4 years . MEASUREMENTS The primary endpoint was recurrent coronary events ; the secondary endpoint was all-cause mortality and other clinical events , including adverse effects . RESULTS Elderly patients were at greater risk for coronary events , death from coronary events , all-cause mortality , and malignancies than younger patients .  Xuezhikang therapy reduced the incidence of coronary events 36.9 % ( P=.001 ) , death from coronary heart disease 31.0 % ( P=.04 ) , all-cause mortality 31.9 % ( P=.01 ) , stroke 44.1 % ( P=.04 ) , the need for a percutaneous coronary intervention or coronary artery bypass graft 48.6 % ( P=.07 ) , and malignancies 51.4 % ( P=.03 ) . Based on the treatment of elderly patients with xuezhikang for an average of 4 years , the number needed to treat ( NNT ) to prevent one coronary event , one coronary death , and one mortality due to all causes was estimated to be 18 , 33 , and 23 , respectively . In a like manner , the estimated NNT to prevent one coronary event , one coronary death , and one mortality due to all causes in younger patients was 23 , 82 , and 51 , respectively . There was not a significantly greater number of adverse effects in the xuezhikang group than in the placebo group . CONCLUSION This is the first study demonstrating that treatment with xuezhikang capsules is safe and effective for the secondary prevention of CHD in older Chinese people Several previous trials from Western population studies have showed that statins may help reduce blood pressure ( BP ) . However , r and omized clinical data is limited . Xuezhikang , a partially extract of red yeast rice , contains a family of naturally occurring statins , and has a marked impact on lipids , but it is unknown whether Xuezhikang has any effect on BP during long-term follow-up in the Chinese population . This is a post-hoc subgroup analysis of a r and omized , double-blinded , placebo-controlled , parallel group clinical trial , Chinese Coronary Secondary Prevention Study ( CCSPS ) . A total of 2704 hypertensive patients with previous myocardial infa rct ion ( MI ) were assigned either to placebo ( n = = 1341 ) or to Xuezhikang ( n = = 1363 ) daily for an average of 4.5 years . The primary outcome was the unadjusted changes in mean arterial pressure ( MAP ) from baseline to 6 months . We also assessed systolic blood pressure ( SBP ) , diastolic blood pressure ( DBP ) , and pulse pressure . Analysis of covariance was used to calculate the adjusted effects of treatment on changes in these outcomes at 6 , 12 , 24 , and 48 months post-r and om- ization , after controlling for potential confounders . This analysis included 2704//4870 ( 55.5%% ) hypertensive patients for whom BP was measured at baseline and at least one follow-up visit after r and omization . Median duration of the follow-up was 4.5 years ( 54 months ) , and 25 patients ( 0.92%% ) were lost to the last follow-up because of adverse effects . The results showed that the unadjusted and adjusted changes in MAP , SBP , DBP , or pulse pressure from baseline were not significantly different for Xuezhikang or placebo recipients at 6 , 12 , 24 , and 48 months after r and omization . In this post-hoc subgroup analysis , we failed to demonstrate any significant reducing effects of Xuezhikang on BP in Chinese hypertensive patients with previous MI , suggesting that further prospect i ve study on the effects of statins on BP would be needed , especially in high-risk patients Coronary heart disease , hypertension , and dyslipidemia are highly prevalent and commonly coexist in people who are middle-aged and older . Previous data suggested that lowering cholesterol concentrations in individuals at high risk of cardiovascular disease improved clinical outcomes . Xuezhikang , a partial extract of red yeast rice containing statin , has a marked impact on lipids . The purpose of this study , therefore , was to evaluate the impact of Xuezhikang on reducing cardiovascular events and mortality in elderly Chinese hypertensive patients with a history of myocardial infa rct ion ( MI ) enrolled in the Chinese Coronary Secondary Prevention Study . In this r and omized trial , 1530 elderly hypertensive patients ( > or = 65-years-old ) with previous MI were assigned either to placebo ( n = 758 ) or to Xuezhikang ( n = 772 ) daily for an average of 4.5 years . The primary endpoint was recurrent coronary events ; the secondary endpoint was all-cause mortality and other clinical events , including adverse effects . There were 68 cases of coronary events ( 8.8 % ) detected in the Xuezhikang group and 108 cases ( 14.3 % ) in the placebo group ( 38.2 % risk reduction by Xuezhikang therapy ) . Death from coronary heart disease ( CHD ) totaled 49 cases in the Xuezhikang group ( 6.4 % ) and 68 cases in the placebo group ( 9.0 % ) , indicating that Xuezhikang significantly decreased the risk of CHD death by 29.2 % . Our study demonstrated that Xuezhikang therapy could effectively and safely reduce cardiovascular events and all-cause death in Chinese elderly hypertensive patients with previous MI . This finding may have an important implication for the treatment of elderly hypertensive patients with CHD Objective To investigate the impacts of Xuezhikang ( 血脂康 , XZK ) or pravastatin combined with antihypertensive drugs on circulating endothelial progenitor cells ( CEPCs ) in essential hypertensive ( EH ) patients . Methods Eighty-eight EH patients were enrolled into the study and r and omly assigned to the antihypertensive drug treatment group ( ATH group , 29 cases ) , the pravastatin treatment group ( PRA group , 29 cases ) and the Xuezhikang treatment group ( XZK group , 30 cases ) . Patients in the 3 groups were treated with routine antihypertensive drugs . In addition , pravastatin and Xuezhikang were given to the patients in the PRA group and XZK group , respectively . After an eight-week treatment , CEPCs were counted using a laser scanning confocal microscope , and their proliferation function was evaluated by the MTT colorimetric assay and the adherent cell number was counted to estimate the adhesion function . Results After the treatment , CEPCs in the PRA group ( 116.60±5.70 ) and XZK group ( 114.40±6.55 ) was significantly higher than that in the ATH group ( 88.00±6.32 , P<0.01 ) . CEPCs proliferation capability and the adhesion function in the PRA group ( 0.406±0.016 , 33.60±4.26 ) and XZK group ( 0.415±0.018 , 34.30±3.77 ) were obviously superior to those in the ATH group ( 0.333±0.021 , P<0.01 ; 23.30±3.19 , P<0.01 ) . No significant difference was found between the pravastatin group and the XZK group . Conclusions Combined use of XZK or pravastatin with the anti-hypertensive therapy could increase the CEPCs number and improve their function in EH patients with the blood pressure controlled by antihypertensive drugs , leading to benefits independent of pressure-lowering effects Lipid-lowering therapy has been proven to reduce macrovascular complications of type 2 diabetes .  Xuezhikang is an extract of cholestin and has a markedly modulating effect on lipids , but the effect of xuezhikang on reducing coronary events in diabetic patients with coronary heart disease ( CHD ) is less clear . A total of 591 diabetic patients with CHD were r and omized to the xuezhikang group ( n = 306 ) and the placebo group ( n = 285 ) . During the average 4 years of follow-up , there were 28 cases of CHD events ( 9.2 % ) in the xuezhikang group and 53 cases ( 18.6 % ) in the placebo group . Risk reduction for CHD events was 50.8 % ( P < 0.001 ) by xuezhikang treatment . Xuezhikang decreased the risk of non-fatal MI by 63.8 % , fatal MI by 58.5 % , CHD sudden death by 26.9 % , and other CHD death by 53.4 % . CHD death totaled to 21 cases in the xuezhikang group ( 6.9 % ) and 35 cases in the placebo group ( 12.3 % ) , indicating that xuezhikang significantly decreased the risk of CHD death by 44.1 % ( P < 0.05 ) . Seventy-two patients died from various causes , among which there were 27 patients in the xuezhikang group and 45 patients in the placebo group . The risk for all-cause death was 44.1 % lower in the xuezhikang group than in the placebo group ( P < 0.01 ) . This investigation demonstrates that xuezhikang therapy can be effective on reduction of cardiovascular events in diabetic patients with CHD with a reliable safety OBJECTIVE To investigate the benefits of long-term therapy with Xuezhikang , a cholestin extract , in combination with calcium channel blockers for improvement of left ventricular ( LV ) hypertrophy and function in patients with essential hypertension , as determined using echocardiography . DESIGN Fifty-five ( 55 ) hypertensive patients with normal blood low-density lipoprotein cholesterol ( LDL-C ) levels were r and omly assigned to the Xuezhikang group ( n = 28 , 1200 mg/d of Xuezhikang ) or the placebo group ( n = 27 , matched placebo ) . All of the patients were treated with extended-release nifedipine ( 20 mg twice daily ) . Thirty ( 30 ) normotensive subjects , matched for age and gender , were selected as a control group . Conventional echocardiography and tissue Doppler imaging were used to measure the left ventricle ( LV ) wall thickness and LV diastolic function at weeks 0 , 24 , and 72 during the period of observation . The serum levels of lipids , carboxy-terminal propeptide of procollagen type I ( PIP ) , and C-reactive protein ( CRP ) were determined as well . RESULTS The hypertensive patients had significantly elevated PIP and CRP levels in serum , increased LV wall thickness , and impaired LV diastolic function compared with the normotensive subjects ( 0.01 < p < 0.05 ) . Compared with the placebo group , the transmitral flow velocities ( E/A ratio ) ( 1.11 + /- 0.36 versus 0.85 + /- 0.24 , p < 0.01 ) and the myocardial motion velocities ( Em/Am ratio ) at the septal mitral annulus ( 0.90 + /- 0.19 versus 0.70 + /- 0.18 , p < 0.05 ) and the lateral mitral annulus ( 1.06 + /- 0.20 versus 0.86 + /- 0.14 , p < 0.01 ) were significantly increased , while there was no significant change in the LV wall thickness after 72 weeks of therapy with Xuezhikang . The serum levels of PIP ( 0.43 + /- 0.13 ng/mL versus 0.51 + /- 0.20 ng/mL , p < 0.05 ) and CRP ( 0.32 + /- 0.13 mg/L versus 0.40 + /-0.17 mg/L , p < 0.05 ) were significantly reduced compared to placebo treatment . There was no significant correlation between changes in LV diastolic function and blood pressure or lipid profile with Xuezhikang therapy . CONCLUSION Long-term therapy with Xuezhikang improved LV diastolic function , probably mediated through antifibrotic and anti-inflammatory effects and independent of blood pressure and lipid profiles in patients with essential hypertension BACKGROUND Small studies have suggested that lipid-lowering strategies , and particularly statins , could influence blood pressure ( BP ) control . The aim of the present study was to evaluate the effect of different lipid-lowering strategies on BP control of subjects with hypercholesterolemia who were enrolled in the prospect i ve , population -based , longitudinal Brisighella Heart Study . METHODS A total of 1356 subjects with total cholesterol levels > or=239 mg/dL were r and omly treated for 5 years ( 1988 - 1993 ) with 1 of these lipid-lowering regimens : low-fat diet , cholestyramine , gemfibrozil , or simvastatin . Participants were divided at baseline into 4 quartiles according to systolic BP level and examined for the percent change in systolic and diastolic BP during the 5 years of treatment . RESULTS A significant decrease in BP was observed in the 2 upper quartiles of systolic BP ( > or=140 mm Hg ) and was greater in subjects treated with cholesterol-lowering drugs who also had a greater reduction in plasma levels of low-density lipoprotein cholesterol . The BP decrease was greater in patients treated with statin drugs and , among those treated with antihypertensive drugs , in subjects in the fourth quartile . CONCLUSION The use of lipid-lowering measures could significantly improve BP control in subjects with both hypercholesterolemia and hypertension . The reduction in BP seems to be enhanced in subjects treated with statins BACKGROUND Statins have been reported to have direct vascular effects independent of cholesterol reduction . To assess the antihypertensive effect of statins , a crossover study was design ed to compare the depressor effect of pravastatin and probucol in hypertensive patients undergoing long-term treatment with antihypertensive drugs . METHODS The subjects enrolled in this study were 52 hypertensive patients ( 22 men and 30 women , mean age 62.8 + /- 9.3 years ) who were treated with the same antihypertensive drugs for more than 1 year and had serum cholesterol levels of more than 5.69 mmol/L. In 26 subjects , pravastatin at a dose of 10 mg/d was given first for 6 months followed by treatment with probucol at a dose of 500 mg/d , and vice versa in the remaining 26 subjects . Serum lipids , apolipoproteins , glucose , and insulin were measured on the final day of the control period , and pravastatin and probucol treatments . The homeostatic model assessment insulin resistance index ( HOMA-IR ) was used to assess insulin resistance . RESULTS The blood pressure decreased after pravastatin treatment ( 141.2 + /- 4.7/81.3 + /- 4.9 to 136.5 + /- 5.3/80.6 + /- 5.1 mm Hg , P < .001/.499 ) , but did not decrease after probucol treatment ( 141.2 + /- 4.7/81.3 + /- 4.9 to 141.4 + /- 4.9/80.8 + /- 4.9 mm Hg , P = .832/.634 ) . Total cholesterol decreased significantly after pravastatin ( 6.69 + /- 0.69 to 5.23 + /- 0.77 mmol/L , P < .001 ) and probucol treatment ( 6.69 + /- 0.69 to 5.53 + /- 0.64 mmol/L , P < .001 ) . The HOMA-IR was decreased by probucol ( 1.92 + /- 0.78 to 1.57 + /- 0.59 , P = .029 ) , whereas pravastatin had no effect on HOMA-IR . CONCLUSIONS It can be concluded that the depressor effect of pravastatin may have an additional benefit in the treatment of hypertensive patients with hyperlipidemia without any adverse effect on insulin sensitivity CONTEXT Although it has been hypothesized that hypertension is in part an inflammatory disorder , clinical data linking inflammation with incident hypertension are scarce . OBJECTIVE To examine whether C-reactive protein levels , a marker of systemic inflammation , are associated with incident hypertension . DESIGN , SETTING , AND PARTICIPANTS A prospect i ve cohort study that began in 1992 of 20 525 female US health professionals aged 45 years or older who provided baseline blood sample s with initially normal levels of blood pressure ( BP ) ( systolic BP < 140 mm Hg and diastolic BP < 90 mm Hg , and no history of hypertension or antihypertensive medications ) and then followed up for a median of 7.8 years for the development of incident hypertension .  Plasma C-reactive protein levels were measured and baseline coronary risk factors were collected . MAIN OUTCOME MEASURE Incident hypertension , defined as either a new physician diagnosis , the initiation of antihypertensive treatment , or self-reported systolic BP of at least 140 mm Hg or a diastolic BP of at least 90 mm Hg . RESULTS During follow-up , 5365 women developed incident hypertension .  In crude models , the relative risks ( RRs ) and 95 % confidence intervals ( CIs ) of developing hypertension from the lowest ( referent ) to the highest levels of baseline C-reactive protein were 1.00 , 1.25 ( 95 % CI , 1.14 - 1.40 ) , 1.51 ( 95 % CI , 1.35 - 1.68 ) , 1.90 ( 95 % CI , 1.72 - 2.11 ) , and 2.50 ( 95 % CI , 2.27 - 2.75 ) ( linear trend P<.001 ) . In fully adjusted models for coronary risk factors , the RRs and 95 % CIs were 1.00 , 1.07 ( 95 % CI , 0.95 - 1.20 ) , 1.17 ( 95 % CI , 1.04 - 1.31 ) , 1.30 ( 95 % CI , 1.17 - 1.45 ) , and 1.52 ( 95 % CI , 1.36 - 1.69 ) ( linear trend P<.001 ) . C-reactive protein was significantly associated with an increased risk of developing hypertension in all prespecified subgroups evaluated , including those with very low levels of baseline BP , as well as those with no traditional coronary risk factors . Similar results were found when treating C-reactive protein as a continuous variable and controlling for baseline BP . CONCLUSION C-reactive protein levels are associated with future development of hypertension , which suggests that hypertension is in part an inflammatory disorder CONTEXT Studies have demonstrated that statins administered to individuals with risk factors for coronary heart disease ( CHD ) reduce CHD events . However , many of these studies were too small to assess all-cause mortality or outcomes in important subgroups . OBJECTIVE To determine whether pravastatin compared with usual care reduces all-cause mortality in older , moderately hypercholesterolemic , hypertensive participants with at least 1 additional CHD risk factor . DESIGN AND SETTING Multicenter ( 513 primarily community-based North American clinical centers ) , r and omized , nonblinded trial conducted from 1994 through March 2002 in a subset of participants from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial ( ALLHAT ) . PARTICIPANTS Ambulatory persons ( n = 10 355 ) , aged 55 years or older , with low-density lipoprotein cholesterol ( LDL-C ) of 120 to 189 mg/dL ( 100 to 129 mg/dL if known CHD ) and triglycerides lower than 350 mg/dL , were r and omized to  pravastatin  ( n = 5170 ) or to  usual care  ( n = 5185 ) . Baseline mean total cholesterol was 224 mg/dL ; LDL-C , 146 mg/dL ; high-density lipoprotein cholesterol , 48 mg/dL ; and triglycerides , 152 mg/dL. Mean age was 66 years , 49 % were women , 38 % black and 23 % Hispanic , 14 % had a history of CHD , and 35 % had type 2 diabetes . INTERVENTION Pravastatin , 40 mg/d , vs usual care . MAIN OUTCOME MEASURES The primary outcome was all-cause mortality , with follow-up for up to 8 years . Secondary outcomes included nonfatal myocardial infa rct ion or fatal CHD ( CHD events ) combined , cause-specific mortality , and cancer . RESULTS Mean follow-up was 4.8 years . During the trial , 32 % of usual care participants with and 29 % without CHD started taking lipid-lowering drugs . At year 4 , total cholesterol levels were reduced by 17 % with pravastatin vs 8 % with usual care ; among the r and om sample who had LDL-C levels assessed , levels were reduced by 28 % with pravastatin vs 11 % with usual care .  All-cause mortality was similar for the 2 groups ( relative risk [ RR ] , 0.99 ; 95 % confidence interval [ CI ] , 0.89 - 1.11 ; P = .88 ) , with 6-year mortality rates of 14.9 % for pravastatin vs 15.3 % with usual care .  CHD event rates were not significantly different between the groups ( RR , 0.91 ; 95 % CI , 0.79 - 1.04 ; P = .16 ) , with 6-year CHD event rates of 9.3 % for pravastatin and 10.4 % for usual care . CONCLUSIONS Pravastatin did not reduce either all-cause mortality or CHD significantly when compared with usual care in older participants with well-controlled hypertension and moderately elevated LDL-C. The results may be due to the modest differential in total cholesterol ( 9.6 % ) and LDL-C ( 16.7 % ) between pravastatin and usual care compared with prior statin trials supporting cardiovascular disease prevention OBJECTIVE To investigate whether xuezhikang has additional beneficial effect on lipid peroxidation , myocardial fibrosis , inflammation and blood pressure control in hypertensive patients without sever hyperlipidemia treated with extended-released nifedipine . METHODS This is a r and omized , single-blind , placebo-controlled study , 100 patients with primary hypertension ( HT ) and normal or lightly elevated cholesterol level were r and omized to receive placebo ( n=49 ) or xuezhikang ( 1200 mg/d , n=51 ) for 24 weeks on top of extended-released nifedipine ( 20 mg , bid ) , 30 healthy volunteers served as controls . Plasma was obtained at baseline and 24 weeks after therapy . Lipids , C-reactive protein ( CRP ) , malondialdehyde ( MDA ) , superoxide dismutase photo-inhibition rate ( SOD-PR ) and type I collagen carboxypropeptide ( PIP ) were measured . RESULTS Normal blood pressure ( < 140/90 mm Hg ) was found in 49 out of 51 xuezhikang treated patients and in 40 out of 49 placebo treated patients ( P<0.01 ) after 24 weeks therapy . Plasma CRP , MDA , SOD-PR and PIP were significantly higher in HT patients than those in normal controls . Plasma CRP , MDA , PIP and SOD-PR were significantly decreased in xuezhikang group while remained unchanged in placebo group after 24 weeks treatment . CONCLUSION In patients with primary hypertension without severe hyperlipidemia treated with nifedipine , xuezhikang treatment exerts additional beneficial effects including better blood pressure control , endothelial function improvement , lipid oxidation loading attenuation and anti-inflammation Hypertension is the most common condition seen in primary care and leads to myocardial infa rct ion , stroke , renal failure , and death if not detected early and treated appropriately . Patients want to be assured that blood pressure ( BP ) treatment will reduce their disease burden , while clinicians want guidance on hypertension management using the best scientific evidence . This report takes a rigorous , evidence -based approach to recommend treatment thresholds , goals , and medications in the management of hypertension in adults . Evidence was drawn from r and omized controlled trials , which represent the gold st and ard for determining efficacy and effectiveness . Evidence quality and recommendations were grade d based on their effect on important outcomes . There is strong evidence to support treating hypertensive persons aged 60 years or older to a  BP goal  of less than 150/90 mm Hg and hypertensive persons 30 through 59 years of age to a diastolic goal of less than 90 mm Hg ; however , there is insufficient evidence in hypertensive persons younger than 60 years for a systolic goal , or in those younger than 30 years for a diastolic goal , so the panel recommends a BP of less than 140/90 mm Hg for those groups based on expert opinion . The same thresholds and goals are recommended for hypertensive adults with diabetes or nondiabetic chronic kidney disease ( CKD ) as for the general hypertensive population younger than 60 years . There is moderate evidence to support initiating drug treatment with an angiotensin-converting enzyme inhibitor , angiotensin receptor blocker , calcium channel blocker , or thiazide-type diuretic in the nonblack hypertensive population , including those with diabetes . In the black hypertensive population , including those with diabetes , a calcium channel blocker or thiazide-type diuretic is recommended as initial therapy . There is moderate evidence to support initial or add-on antihypertensive therapy with an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker in persons with CKD to improve kidney outcomes . Although this guideline provides evidence -based recommendations for the management of high BP and should meet the clinical needs of most patients , these recommendations are not a substitute for clinical judgment , and decisions about care must carefully consider and incorporate the clinical characteristics and circumstances of each individual patient C-reactive  protein ( CRP ) , an acute phase reactant and marker of inflammation , has been shown to be associated with CRP genetic variants and incident hypertension , but it is unclear whether this link is causal . We therefore conducted a prospect i ve , nested case – control study to examine the relationship between single-nucleotide polymorphisms ( SNPs ) within the CRP gene , circulating CRP levels and the development of hypertension . Plasma CRP levels and the genotypes of eight SNPs were determined in 2000 unrelated Shanghai residents , including 908 hypertensive individuals and 1092 normotensive individuals . Among the 1092 normotensives , 968 subjects were followed up for 2 years , during which 71 developed hypertension . Plasma CRP levels were independently associated with the development of hypertension in the follow-up study ( odds ratio per quartile=1.64 ; 95 % confidence interval : 1.18–2.26 ; P<0.001 ) . The minor alleles of rs1130864 ( P<0.001 ) and rs3093059 ( P<0.001 ) were significantly associated with elevated CRP levels , and the minor alleles of rs1205 , rs1800947 and rs2246469 ( all P<0.001 ) were associated with decreased CRP levels . A haplotype-based analysis strengthened the results of single-locus analysis . However , none of the SNPs or haplotypes was significantly associated with blood pressure , incident hypertension or changes between baseline and follow-up blood pressure levels . Taken together , our findings demonstrated that plasma CRP levels were substantially associated with common genetic variants in the CRP gene and could predict the development of hypertension . However , the relationship between genotype and CRP levels was not associated with a change in hypertension risk
target: “ RYR plus conventional therapy ” exhibited significant lowering effects on serum total cholesterol ( TC ) , low-density lipoprotein cholesterol ( LDL-C ) , and CRP but exhibited no significant effect on systolic BP , diastolic BP , triglycerides ( TG ) , and high-density lipoprotein cholesterol ( HDL-C ) compared with “ placebo plus conventional therapy . ” “
  RYR plus conventional therapy ” showed significant lowering effects on systolic BP , TC , LDL-C , and CRP but no effect on diastolic BP , TG , and HDL-C compared with “ placebo plus conventional therapy . ”
  No significant difference in BP and lipid profile between “ RYR plus conventional therapy ” and “ statins plus conventional therapy ” was observed .
  “ RYR plus statins ” appeared to be more effective in lowering BP , TC , TG , and LDL-C but without a significant difference in HDL-C compared to statins .
  No serious adverse events were reported .
  The results of this meta- analysis suggested some supportive but limited evidence regarding RYR for hypertension .
background: ABSTRACT Interest is increasing regarding the potential health effects of red yeast rice ( RYR ) consumption , which is described as a “ natural statin ” in China .
  This review aims to evaluate the efficacy of RYR on blood pressure ( BP ) , lipid profile , and C-reactive protein ( CRP ) in treating  hypertension .