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Cardiovascular risk reduction in hypertensive black patients with left ventricular hypertrophy: the LIFE study

Julius, S. (author)
Alderman, M. H. (author)
Beevers, G. (author)
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Dahlöf, Björn, 1953 (author)
Gothenburg University,Göteborgs universitet,Hjärt-kärlinstitutionen,Cardiovascular Institute
Devereux, R. B. (author)
Douglas, J. G. (author)
Edelman, J. M. (author)
Harris, K. E. (author)
Kjeldsen, S. E. (author)
Nesbitt, S. (author)
Randall, O. S. (author)
Wright, J. T., Jr. (author)
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 (creator_code:org_t)
2004
2004
English.
In: J Am Coll Cardiol. - 0735-1097. ; 43:6, s. 1047-55
Related links:
https://gup.ub.gu.se...
  • Journal article (peer-reviewed)
Abstract Subject headings
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  • OBJECTIVES: We report on a subanalysis of the effects of losartan and atenolol on cardiovascular events in black patients in the Losartan Intervention For Endpoint reduction in hypertension (LIFE) study. BACKGROUND: The LIFE study compared losartan-based to atenolol-based therapy in 9,193 hypertensive patients with left ventricular hypertrophy (LVH). Overall, the risk of the primary composite end point (cardiovascular death, stroke, myocardial infarction) was reduced by 13% (p = 0.021) with losartan, with similar blood pressure (BP) reduction in both treatment groups. There was a suggestion of interaction between ethnic background and treatment (p = 0.057). METHODS: Exploratory analyses were performed that placed LIFE study patients into black (n = 533) and non-black (n = 8,660) categories, overall, and in the U.S. (African American [n = 523]; non-black [n = 1,184]). RESULTS: A significant interaction existed between the dichotomized groups (black/non-black) and treatment (p = 0.005); a test for qualitative interaction was also significant (p = 0.016). The hazard ratio (losartan relative to atenolol) for the primary end point favored atenolol in black patients (1.666 [95% confidence interval (CI) 1.043 to 2.661]; p = 0.033) and favored losartan in non-blacks (0.829 [95% CI 0.733 to 0.938]; p = 0.003). In black patients, BP reduction was similar in both groups, and regression of electrocardiographic-LVH was greater with losartan. CONCLUSIONS: Results of the subanalysis are sufficient to generate the hypothesis that black patients with hypertension and LVH might not respond as favorably to losartan-based treatment as non-black patients with respect to cardiovascular outcomes, and do not support a recommendation for losartan as a first-line treatment for this purpose. The subanalysis is limited by the relatively small number of events.

Keyword

African Continental Ancestry Group
Aged
Aged
80 and over
Antihypertensive Agents/administration & dosage/*therapeutic use
Asian Continental Ancestry Group
Atenolol/administration & dosage/*therapeutic use
Blood Pressure/drug effects
Drug Therapy
Combination
Europe
European Continental Ancestry Group
Female
Humans
Hypertension/complications/genetics/mortality/*prevention & control
Hypertrophy
Left Ventricular/*complications
Losartan/administration & dosage/*therapeutic use
Male
Middle Aged
Treatment Outcome
United States

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