TY - JOUR
T1 - Cardiovascular risk reduction in hypertensive black patients with left ventricular hypertrophy
T2 - The life study
AU - Julius, Stevo
AU - Alderman, Michael H.
AU - Beevers, Gareth
AU - Dahlöf, Björn
AU - Devereux, Richard B.
AU - Douglas, Janice G.
AU - Edelman, Jonathan M.
AU - Harris, Katherine E.
AU - Kjeldsen, Sverre E.
AU - Nesbitt, Shawna
AU - Randall, Otelio S.
AU - Wright, Jackson T.
PY - 2004/3/17
Y1 - 2004/3/17
N2 - 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.
AB - 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.
KW - ACE
KW - ALLHAT
KW - Angiotensin-converting enzyme
KW - Antihypertensive therapy and Lipid Lowering Heart Attack prevention Trial
KW - BP
KW - Blood pressure
KW - CHD
KW - CI
KW - Confidence interval
KW - Coronary heart disease
KW - ECG
KW - Electrocardiogram/electrocardiographic
KW - ISH
UR - http://www.scopus.com/inward/record.url?scp=12144290821&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=12144290821&partnerID=8YFLogxK
U2 - 10.1016/j.jacc.2003.11.029
DO - 10.1016/j.jacc.2003.11.029
M3 - Article
C2 - 15028365
AN - SCOPUS:12144290821
SN - 0735-1097
VL - 43
SP - 1047
EP - 1055
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 6
ER -