Cardiovascular risk reduction in hypertensive black patients with left ventricular hypertrophy: the LIFE study.
J Am Coll Cardiol
; 43(6): 1047-55, 2004 Mar 17.
Article
em En
| MEDLINE
| ID: mdl-15028365
ABSTRACT
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.
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Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Atenolol
/
Hipertrofia Ventricular Esquerda
/
Losartan
/
Hipertensão
/
Anti-Hipertensivos
Tipo de estudo:
Clinical_trials
/
Etiology_studies
/
Guideline
/
Qualitative_research
/
Risk_factors_studies
Limite:
Aged
/
Aged80
/
Female
/
Humans
/
Male
/
Middle aged
País/Região como assunto:
America do norte
/
Europa
Idioma:
En
Revista:
J Am Coll Cardiol
Ano de publicação:
2004
Tipo de documento:
Article
País de afiliação:
Estados Unidos