title: Racial differences in incident heart failure during antihypertensive therapy.
abstract: BACKGROUND
  Blacks have a higher prevalence of heart failure (HF) than nonblacks, possibly reflecting a greater burden of HF risk factors, including hypertension. Although HF incidence is significantly higher in blacks during long-term follow-up of young adults, the relationship of incident HF to race in hypertensive patients undergoing treatment is unclear.
  
  
  RESULTS
  Incident HF was evaluated in 497 black and 8199 nonblack hypertensive patients with no history of HF randomly assigned to losartan- or atenolol-based treatment. During 4.7±1.1 years mean follow-up, HF hospitalization occurred in 265 patients (3.0%); 5-year HF incidence was significantly greater in black than nonblack patients (7.0 versus 3.1%, P<0.001). In Cox multivariate analyses adjusting for randomized treatment, age, sex, the presence of the strain pattern on the baseline ECG, and other HF risk factors treated as standard covariates, and for incident myocardial infarction, in-treatment QRS duration, diastolic and systolic pressure, Cornell product, and Sokolow-Lyon voltage criteria for left ventricular hypertrophy (LVH) treated as time-varying covariates, black race remained associated with a 130% increased risk of developing new HF (hazard ratio 2.30, 95% confidence interval 1.24 to 4.28).
  
  
  CONCLUSIONS
  Incident HF is substantially more common among black than nonblack hypertensive patients. The increased risk of developing new HF in blacks persists after adjusting for the higher prevalence of HF risk factors in blacks, for treatment effects and in-treatment blood pressure, and for the known predictive value of the ECG strain pattern and in-treatment ECG LVH and QRS duration for incident HF in this population. Clinical Trial Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT00338260.
authors.affiliation: Division of Cardiology, Weill Cornell Medical College, New York, NY 10065, USA. pokin@med.cornell.edu
authors.forename: Peter M
authors.initials: PM
authors.lastname: Okin
authors.forename: Sverre E
authors.initials: SE
authors.lastname: Kjeldsen
authors.forename: Björn
authors.initials: B
authors.lastname: Dahlöf
authors.forename: Richard B
authors.initials: RB
authors.lastname: Devereux
mesh_terms: D001741:Black or African American; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001213:Asian; D001794:Blood Pressure / Q000502:physiology; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000453:epidemiology* / Q000208:ethnology* / Q000503:physiopathology; D006630:Hispanic or Latino; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy* / Q000208:ethnology*; D017379:Hypertrophy, Left Ventricular / Q000150:complications / Q000000981:diagnostic imaging; D015994:Incidence; D053208:Kaplan-Meier Estimate; D019808:Losartan / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D044469:Racial Groups; D012307:Risk Factors; D014463:Ultrasonography; D044465:White People
chemical_list: D000959:Antihypertensive Agents; D019808:Losartan