Document Detail


Effects of losartan compared with atenolol on lipids in patients with hypertension and left ventricular hypertrophy: the Losartan Intervention For Endpoint reduction in hypertension study.
MedLine Citation:
PMID:  19262226     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Beta-blockers and angiotensin II receptor blockers have different effects on lipids. METHODS: We examined lipid levels in the Losartan Intervention For Endpoint reduction in hypertension study and their impact on the primary composite endpoint of cardiovascular death, myocardial infarction, or stroke. We measured total and high-density lipoprotein cholesterol at baseline and annually during 4.8 years of losartan-based compared with atenolol-based treatment in 8611 patients with hypertension and left ventricular hypertrophy. RESULTS: Patients randomized to losartan-based or atenolol-based treatment had similar baseline total (6.04 +/- 1.12 vs. 6.05 +/- 1.13 mmol/l, NS) and high-density lipoprotein (HDL) cholesterol (1.50 +/- 0.44 vs. 1.49 +/- 0.44 mmol/l, NS). Total cholesterol decreased significantly but equally (-0.37 +/- 1.05 vs. -0.34 +/- 1.09 mmol/l, NS), whereas HDL cholesterol decreased less during the first 2 years in patients randomized to losartan compared with atenolol (-0.13 +/- 0.24 vs. -0.19 +/- 0.25 mmol/l) and remained higher each year (1.38, 1.37, 1.42, 1.47, and 1.48 mmol/l vs. 1.32, 1.30, 1.36, 1.40, and 1.42 mmol/l, all P < 0.001) independent of hydrochlorothiazide or statin treatment. In Cox regression analysis, baseline total cholesterol [hazard ratio (HR) = 1.08 (1.02-1.14) per mmol/l, P < 0.01], HDL cholesterol [HR = 0.56 (0.48-0.66) per mmol/l, P < 0.001], and treatment allocation [HR = 0.86 (0.76-0.98), P < 0.05] predicted composite endpoint independently. Using time-varying analyses, the predictive strength of HDL cholesterol was increased [HR = 0.36 (0.30-0.44) per mmol/l, P < 0.001], whereas that of total cholesterol [HR = 1.03 (0.97-1.09) per mmol/l, NS] and treatment allocation [HR = 0.91 (0.80-1.03), NS] were reduced. CONCLUSION: Losartan blunted the decrease in HDL cholesterol during antihypertensive treatment in the LIFE study. Higher intreatment HDL cholesterol was associated with fewer composite endpoints and may partly explain the better outcome of losartan-based treatment.
Authors:
Michael Hecht Olsen; Kristian Wachtell; Gareth Beevers; Björn Dahlöf; Giovanni de Simone; Richard B Devereux; Ulf de Faire; Frej Fyhrquist; Hans Ibsen; Sverre E Kjeldsen; Ole Lederballe-Pedersen; Lars H Lindholm; Paulette A Lyle; Markku S Nieminen; Per Omvik; Suzanne Oparil; Hans Wedel
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of hypertension     Volume:  27     ISSN:  1473-5598     ISO Abbreviation:  J. Hypertens.     Publication Date:  2009 Mar 
Date Detail:
Created Date:  2009-03-12     Completed Date:  2009-07-23     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8306882     Medline TA:  J Hypertens     Country:  England    
Other Details:
Languages:  eng     Pagination:  567-74     Citation Subset:  IM    
Affiliation:
Glostrup University Hospital, Glostrup, Denmark. mho@dadlnet.dk
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MeSH Terms
Descriptor/Qualifier:
Aged
Antihypertensive Agents / therapeutic use*
Blood Pressure / drug effects
Cardiovascular Diseases / mortality
Cholesterol / blood
Cholesterol, HDL / blood
Diastole
Dose-Response Relationship, Drug
Electrocardiography
Female
Follow-Up Studies
Humans
Hypertension / complications,  drug therapy*
Hypertrophy, Left Ventricular / complications,  drug therapy*
Lipid Metabolism / drug effects*
Losartan / therapeutic use*
Male
Middle Aged
Multicenter Studies as Topic
Randomized Controlled Trials as Topic
Time Factors
Treatment Outcome
Chemical
Reg. No./Substance:
0/Antihypertensive Agents; 0/Cholesterol, HDL; 114798-26-4/Losartan; 57-88-5/Cholesterol
Comments/Corrections
Comment In:
J Hypertens. 2009 Mar;27(3):458-60   [PMID:  19262224 ]

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


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