Does albuminuria predict cardiovascular outcome on treatment with losartan versus atenolol in hypertension with left ventricular hypertrophy? A LIFE substudy.
OBJECTIVE
To examine a possible relationship between baseline albuminuria and effect of losartan versus atenolol on cardiovascular (CV) events in hypertensive patients with left ventricular hypertrophy, the effect of losartan versus atenolol on albuminuria, and whether the benefits of losartan versus atenolol could be explained by influence of losartan on albuminuria.


METHODS
Double-blind, randomized, controlled trial of 4.8 years.


METHODS
Out-patient setting.


METHODS
A total of 8206 with hypertension and left ventricular hypertrophy.


METHODS
Losartan or atenolol, supplemented with diuretics and/or calcium antagonists to reach blood pressure < 140/90 mmHg


METHODS
The urine albumin/creatinine ratio, and the primary composite endpoint (CEP) of CV death, myocardial infarction, and stroke.


RESULTS
The blood pressure was reduced similarly on losartan (30.2/16.6 mmHg) versus atenolol (29.1/16.8 mmHg). The risk of a primary CEP increased linearly from the lowest to the highest decile of baseline albuminuria. The benefits of losartan versus atenolol for the primary CEP and for stroke tended to be more pronounced among patients above the median value for baseline albuminuria (urine albumin/creatinine ratio, 1.28 mg/mmol). The decrease in albuminuria was significantly greater with losartan versus atenolol throughout the study (a decrease from baseline to year 2 of 33% losartan versus 25% atenolol). One-fifth of the difference in favor of losartan on the primary CEP was explained by the greater reduction in albuminuria on losartan.


CONCLUSIONS
Baseline albuminuria is a powerful risk factor for CV events. Baseline albuminuria did not identify the group of patients with greatest benefit on losartan versus atenolol in LIFE. Reduction in albuminuria explained one-fifth of the benefits of losartan versus atenolol.
Glostrup University Hospital, Denmark. haib@glostruphosp.kbhamt.dk
Hans
H
Ibsen
Kristian
K
Wachtell
Michael H
MH
Olsen
Knut
K
Borch-Johnsen
Lars H
LH
Lindholm
Carl Erik
CE
Mogensen
Björn
B
Dahlöf
Richard B
RB
Devereux
Ulf
U
de Faire
Frej
F
Fyhrquist
Stevo
S
Julius
Sverre E
SE
Kjeldsen
Ole
O
Lederballe-Pedersen
Markku S
MS
Nieminen
Per
P
Omvik
Suzanne
S
Oparil
Ying
Y
Wan
D000368:Aged; D000369:Aged, 80 and over; D000419:Albuminuria / Q000175:diagnosis / Q000453:epidemiology*; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D001262:Atenolol / Q000008:administration & dosage*; D001794:Blood Pressure / Q000187:drug effects; D004232:Diuretics / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D017379:Hypertrophy, Left Ventricular / Q000453:epidemiology*; D019808:Losartan / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D011237:Predictive Value of Tests; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology
D000959:Antihypertensive Agents; D004232:Diuretics; D001262:Atenolol; D019808:Losartan