Cardiovascular risk reduction in hypertensive black patients with left ventricular hypertrophy: the LIFE study.
OBJECTIVE
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.
Julius
Stevo
S
Department of Internal Medicine, Division of Hypertension, University of Michigan Medical Center, 3918 Taubman Center, Ann Arbor, MI 48109-0356, USA. sjulius@umich.edu
Alderman
Michael H
MH
Beevers
Gareth
G
Dahlöf
Björn
B
Devereux
Richard B
RB
Douglas
Janice G
JG
Edelman
Jonathan M
JM
Harris
Katherine E
KE
Kjeldsen
Sverre E
SE
Nesbitt
Shawna
S
Randall
Otelio S
OS
Wright
Jackson T
JT
D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D044466:Asian People; D001262:Atenolol / Q000008:administration & dosage / Q000627:therapeutic use*; D044383:Black People; D001794:Blood Pressure / Q000187:drug effects; D004359:Drug Therapy, Combination; D005060:Europe; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000235:genetics / Q000401:mortality / Q000517:prevention & control*; D017379:Hypertrophy, Left Ventricular / Q000150:complications*; D019808:Losartan / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D014481:United States; D044465:White People; D001741:Black or African American
D000959:Antihypertensive Agents; D001262:Atenolol; D019808:Losartan