Left Ventricular Wall Stress-Mass-Heart Rate Product and Cardiovascular Events in Treated Hypertensive Patients LIFE Study

• In the Losartan Intervention for End Point Reduction in Hypertension (LIFE) study, 4.8 years' losartan- versus atenolol-based antihypertensive treatment reduced left ventricular hypertrophy and cardiovascular end points, including cardiovascular death and stroke. However, there was no difference in myocardial infarction (MI), possibly related to greater reduction in myocardial oxygen demand by atenolol-based treatment. Myocardial oxygen demand was assessed indirectly by the left ventricular massxwall stressxheart rate (triple product) in 905 LIFE participants. The triple product was included as time-varying covariate in Cox models assessing predictors of the LIFE primary composite end point (cardiovascular death, MI, or stroke), its individual components, and all-cause mortality. At baseline, the triple product in both treatment groups was, compared with normal adults, elevated in 70% of patients. During randomized treatment, the triple product was reduced more by atenolol, with prevalences of elevated triple product of 39% versus 51% on losartan (both P0.001). In Cox regression analyses adjusting for age, smoking, diabetes mellitus, and prior stroke, MI, and heart failure, 1 SD lower triple product was associated with 23% (95% confidence interval 13%-32%) fewer composite end points, 31% (18%-41%) less cardiovascular mortality, 30% (15%-41%) lower MI, and 22% (11%-33%) lower all-cause mortality (all P0.001), without association with stroke (P=0.34). Although losartan-based therapy reduced ventricular mass more, greater heart rate reduction with atenolol resulted in larger reduction of the triple product. Lower triple product during antihypertensive treatment was strongly, independently associated with lower rates of the LIFE primary composite end point, cardiovascular death, and MI, but not stroke.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Kardiologi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)

Nyckelord

hypertension

hypertrophy

myocardial infarction

oxygen

prognosis

VEREUX RB

1986

AMERICAN JOURNAL OF CARDIOLOGY

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P450 vereux RB

2004

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION

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P2350

LLSPERGER KC

1988

CIRCULATION RESEARCH

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P87

VEREUX RB

1993

CIRCULATION

V88

P1444 hlof B

1997

AMERICAN JOURNAL OF HYPERTENSION

V10

P705 nonymous]

1981

N Engl J Med

V304

P801 hlof B

2002

LANCET

V359

P995 hiller N B

1989

Journal of the American Society of Echocardiography : official publication of the erican Society of Echocardiography

V2

P358 vereux RB

2000

JOURNAL OF HYPERTENSION

V18

P1129 in PM

2003

CIRCULATION

V108

P684

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