title: Hospitalizations for new heart failure among subjects with diabetes mellitus in the RENAAL and LIFE studies.
abstract: We sought to study the risk factors for heart failure (HF) and the relation between antihypertensive treatment with losartan and the first hospitalization for HF in patients with diabetes mellitus in the Losartan Intervention For Endpoint reduction in hypertension (LIFE) and Reduction of Endpoints in NIDDM with the Angiotensin II Antagonist Losartan (RENAAL) studies. We evaluated 1,195 patients with hypertension, left ventricular hypertrophy, and diabetes from the LIFE study and 1,513 patients with type 2 diabetes and nephropathy from the RENAAL study. The comparative treatments were atenolol in the LIFE study and placebo in the RENAAL study. Patients with a history of HF were excluded from this analysis. Losartan significantly reduced the incidence of first hospitalizations for HF versus placebo in the RENAAL study (hazard ratio 0.74, p=0.037) and versus atenolol in the LIFE study (hazard ratio 0.57, p=0.019). Patients enrolled in the RENAAL study were at a higher risk of developing HF (hazard ratio for RENAAL vs LIFE diabetics 3.0, p<0.0001). The significant, independent baseline risk factors for the development of HF in the RENAAL study were urinary albumin/creatinine ratio, age, peripheral vascular disease, the Cornell product, body mass index, and previous angina; in the LIFE study they were the Cornell product, previous myocardial infarction, peripheral vascular disease, baseline atrial fibrillation, alcohol use (inverse relation), and urinary albumin/creatinine ratio. The beneficial effect of losartan on the reduction of risk for hospitalization for new HF was demonstrated in patients who were at high renal and/or high cardiovascular risk.
authors.affiliation: Circulatory Disease Center, Augusta, Georgia, USA. alcarrmd@aol.com
authors.forename: Albert A
authors.initials: AA
authors.lastname: Carr
authors.forename: Peter R
authors.initials: PR
authors.lastname: Kowey
authors.forename: Richard B
authors.initials: RB
authors.lastname: Devereux
authors.forename: Barry M
authors.initials: BM
authors.lastname: Brenner
authors.forename: Björn
authors.initials: B
authors.lastname: Dahlöf
authors.forename: Hans
authors.initials: H
authors.lastname: Ibsen
authors.forename: Lars H
authors.initials: LH
authors.lastname: Lindholm
authors.forename: Paulette A
authors.initials: PA
authors.lastname: Lyle
authors.forename: Steven M
authors.initials: SM
authors.lastname: Snapinn
authors.forename: Zhongxin
authors.initials: Z
authors.lastname: Zhang
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Edelman
authors.forename: Shahnaz
authors.initials: S
authors.lastname: Shahinfar
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D000369:Aged, 80 and over; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use*; D001262:Atenolol / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000188:drug therapy; D003928:Diabetic Nephropathies / Q000150:complications / Q000517:prevention & control; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D006760:Hospitalization; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology; D019808:Losartan / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D047228:Angiotensin II Type 1 Receptor Blockers; D001262:Atenolol; D019808:Losartan