Document Detail


Cardiovascular risk reduction in hypertensive black patients with left ventricular hypertrophy: the LIFE study.
MedLine Citation:
PMID:  15028365     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Stevo Julius; Michael H Alderman; Gareth Beevers; Björn Dahlöf; Richard B Devereux; Janice G Douglas; Jonathan M Edelman; Katherine E Harris; Sverre E Kjeldsen; Shawna Nesbitt; Otelio S Randall; Jackson T Wright
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Publication Detail:
Type:  Clinical Trial; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  43     ISSN:  0735-1097     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2004 Mar 
Date Detail:
Created Date:  2004-03-18     Completed Date:  2004-04-06     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1047-55     Citation Subset:  AIM; IM    
Affiliation:
Department of Internal Medicine, Division of Hypertension, University of Michigan Medical Center, 3918 Taubman Center, Ann Arbor, MI 48109-0356, USA. sjulius@umich.edu
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MeSH Terms
Descriptor/Qualifier:
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
Chemical
Reg. No./Substance:
0/Antihypertensive Agents; 114798-26-4/Losartan; 29122-68-7/Atenolol

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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