title: Pulse pressure and effects of losartan or atenolol in patients with hypertension and left ventricular hypertrophy.
abstract: In the Losartan Intervention For Endpoint reduction in hypertension (LIFE) study, the primary composite end point of cardiovascular death, stroke, and myocardial infarction was reduced by losartan versus atenolol in patients with hypertension and left ventricular hypertrophy. The objective of this post hoc analysis was to determine the influence of pulse pressure on outcome. Patients were divided into quartiles of baseline pulse pressure. Cox regression, including baseline Framingham risk score as a covariate, was used to compare risk in the quartiles. In the atenolol group, there were significantly higher risks in the highest versus lowest quartile for the composite end point 28% (confidence interval [CI], 2% to 62%; P=0.035), stroke 84% (CI, 32% to 157%; P<0.001), and total mortality 41% (CI, 7% to 84%; P=0.013). Risk for myocardial infarction was 44% higher (CI, -5% to 120%; P=0.089). The risks in the losartan group also increased with increasing quartile, but were lower than in the atenolol group, and differences between the highest and lowest quartiles were not significant: composite end point 12% (CI, -13% to 44%; P>0.2), stroke -5% (CI, -34% to 37%; P>0.2), myocardial infarction 30% (CI, -13% to 94%; P>0.2), and total mortality 32% (CI, -1% to 76%; P=0.062). In patients with hypertension and left ventricular hypertrophy in the LIFE study, there were significantly higher risks, adjusted for the Framingham risk score, for the primary composite end point, stroke, and total mortality in the highest versus lowest quartile of pulse pressure with atenolol-based treatment. The risks in the losartan group also increased with increasing pulse pressure quartile, but were lower than those in the atenolol group, and were not significant.
authors.affiliation: Helsinki University Central Hospital, Department of Medicine, and Minerva Institute for Medical Research, Helsinki, Finland. frej.fyhrquist@helsinki.fi
authors.forename: Frej
authors.initials: F
authors.lastname: Fyhrquist
authors.forename: Björn
authors.initials: B
authors.lastname: Dahlöf
authors.forename: Richard B
authors.initials: RB
authors.lastname: Devereux
authors.forename: Sverre E
authors.initials: SE
authors.lastname: Kjeldsen
authors.forename: Stevo
authors.initials: S
authors.lastname: Julius
authors.forename: Gareth
authors.initials: G
authors.lastname: Beevers
authors.forename: Ulf
authors.initials: U
authors.lastname: de Faire
authors.forename: Hans
authors.initials: H
authors.lastname: Ibsen
authors.forename: Krister
authors.initials: K
authors.lastname: Kristianson
authors.forename: Ole
authors.initials: O
authors.lastname: Lederballe-Pedersen
authors.forename: Lars H
authors.initials: LH
authors.lastname: Lindholm
authors.forename: Markku S
authors.initials: MS
authors.lastname: Nieminen
authors.forename: Per
authors.initials: P
authors.lastname: Omvik
authors.forename: Suzanne
authors.initials: S
authors.lastname: Oparil
authors.forename: Darcy A
authors.initials: DA
authors.lastname: Hille
authors.forename: Paulette A
authors.initials: PA
authors.lastname: Lyle
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Edelman
authors.forename: Steven M
authors.initials: SM
authors.lastname: Snapinn
authors.forename: Hans
authors.initials: H
authors.lastname: Wedel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001262:Atenolol / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology*; D017379:Hypertrophy, Left Ventricular / Q000209:etiology*; D019808:Losartan / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D016016:Proportional Hazards Models; D016032:Randomized Controlled Trials as Topic; D012306:Risk; D020521:Stroke / Q000209:etiology
chemical_list: D000959:Antihypertensive Agents; D001262:Atenolol; D019808:Losartan