BEMPEDOIC ACID: A NEW MODULATOR OF BLOOD PRESSURE AND THE GLOBAL CARDIOVASCULAR RISK OF THE HYPERTENSIVE AND HYPER-CHOLESTEROLEMIC OUT-PATIENT?
- Journal of Hypertension
- May 2026
Objective:
In the 2025 update of the ESC/EAS guidelines for the management of dyslipidemias bempedoic acid (BA) has gained a stronger recommendation, as it has shown able in both LDL-C lowering and in reducing cardiovascular (CV) events. BA has been shown to reduce systemic inflammation and having some ancillary metabolic effects, but it's possible effects on blood pressure (BP) levels have never been investigated. The efficacy on BP and LDL-C levels of treatment with BA alone or in fixed-combination with ezetimibe in hypertensive and hyper-cholesterolemic subjects in primary prevention (PP) or secondary prevention (SP) for CV diseases was evaluated.
Design and method:
In 362 subjects (mean age 64.0±7.8 years, 53.9% men, 43.6% in PP), with uncontrolled LDL-C values (mean 132.3±32.6 mg/dl) despite lipid-lowering therapy, an oral treatment with BA or BA/E, 180 mg or 180/10 mg once daily respectively, was added. The changes on office and home-BP (HBPM) systolic BP (SBP)/diastolic BP (DBP) and LDL-C values were evaluated at 3, 6 and 12 month of follow-up (FW) as in PP and in SP. Categorical variables were compared with the X2 test, while differences between continuous variables were evaluated by the analysis of co-variance (ANCOVA).
Results:
Office SBP/DBP values significantly (p<0.001) reduced during the FW both in PP (-2.88/1.85, -3.2/2.051, -3.32/2.15 mmHg) and in SP (-1.77/1.10, -2.20/1.3, -1.93/1.25 mmHg). In the manner SBP/DBP HBPM values significantly (p<0.001) reduced both in PP (-3.2/1.6, -3.9/1.9 and -4.6/2.2 mmHg) and in SP (-1.9/0.9, -2.4/1.1 and -2.8/1.3 mmHg). In the whole population, a significant LDL-C reduction was found during the FW (115±11.8, 105±11.0 and 95±10.0 mg/dl respectively, P-value for trend baseline vs. FW, p<0.001).
Conclusions:
In the real world, our findings support the BP lowering effect of BA as a promising treatment option for hypertensive and hyper-cholesterolemic subjects. However, larger studies with a longer FW are mandatory to provide more definitive evidences.
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