Cardiovascular risk reduction in hypertensive black patients with left ventricular hypertrophy: the LIFE study

J Am Coll Cardiol. 2004 Mar 17;43(6):1047-55. doi: 10.1016/j.jacc.2003.11.029.

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.

Publication types

  • Clinical Trial
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • African Continental Ancestry Group
  • Aged
  • Aged, 80 and over
  • Antihypertensive Agents / administration & dosage
  • Antihypertensive Agents / therapeutic use*
  • Asian Continental Ancestry Group
  • Atenolol / administration & dosage
  • Atenolol / therapeutic use*
  • Blood Pressure / drug effects
  • Drug Therapy, Combination
  • Europe
  • European Continental Ancestry Group
  • Female
  • Humans
  • Hypertension / complications
  • Hypertension / genetics
  • Hypertension / mortality
  • Hypertension / prevention & control*
  • Hypertrophy, Left Ventricular / complications*
  • Losartan / administration & dosage
  • Losartan / therapeutic use*
  • Male
  • Middle Aged
  • Treatment Outcome
  • United States

Substances

  • Antihypertensive Agents
  • Atenolol
  • Losartan