Impact of losartan on stroke risk in hypertensive patients in primary care.
OBJECTIVE
While a number of conditions and risk factors that increase stroke risk have been identified, arterial hypertension is the most consistent and powerful predictor. The angiotensin II type 1 receptor antagonist (angio-tensin receptor blocker [ARB]) losartan has been shown in the LIFE (Losartan Intervention for Endpoint Reduction in Hypertension) study to decrease stroke risk in hypertensive patients to a substantially greater extent than conventional therapy. We aimed to assess the impact of the blood pressure-lowering effect of losartan therapy on stroke risk in hypertensive patients in primary care.


METHODS
A total of 2977 primary-care practices throughout Germany included 22 499 consecutive unselected patients with a confirmed diagnosis of hypertension in an open-label, prospective, observational study. In addition to demographics, known risk factors for stroke were documented on standardised questionnaires. The 10-year predicted risk of first stroke was calculated according to the Framingham Stroke Risk Score at baseline and after a mean of 94 +/- 24 days of losartan (+/- hydrochlorothiazide [HCTZ]) therapy.


RESULTS
The mean patient age was 64.1 +/- 10.6 years, and 52.4% were males. Mean systolic/diastolic blood pressure decreased from 160 +/- 15/93 +/- 9 mm Hg at baseline by -21 +/- 14/-11 +/- 9 mm Hg. Besides hypertension, 84.9% of patients had other co-morbidities, of which the most frequent were hypercholesterolaemia (53.0%), diabetes mellitus (36.1%), coronary heart disease (31.1%) and left ventricular hypertrophy (24.2%). The average predicted 10-year stroke risk was 28.0 +/- 21.9% at baseline, and 22.1 +/- 19.5% at study end (relative risk reduction 24 +/- 16%, p<0.05). In subgroups of patients with diabetes or nephropathy, similar effects were noted. Drug-related adverse events were reported in 18 patients; all of these were non-serious.


CONCLUSIONS
Because of the high prevalence of co-morbidities and risk factors, the hypertensive patient population observed in this study presented with a high 10-year stroke risk. Treatment with losartan (+/- HCTZ) was well tolerated and led to a substantial decrease in blood pressure and associated stroke risk.
Bestehorn
K
K
Medical Department, MSD Sharp & Dohme GmbH, Munich/Haar, Germany. kurt.bestehorn@msd.de
Wahle
Klaus
K
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D047228:Angiotensin II Type 1 Receptor Blockers / Q000009:adverse effects / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D005858:Germany; D006801:Humans; D006852:Hydrochlorothiazide / Q000009:adverse effects / Q000627:therapeutic use; D006973:Hypertension / Q000188:drug therapy*; D019808:Losartan / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D012306:Risk; D020521:Stroke / Q000517:prevention & control
D047228:Angiotensin II Type 1 Receptor Blockers; D000959:Antihypertensive Agents; D006852:Hydrochlorothiazide; D019808:Losartan