title: Racial differences in sudden cardiac death among hypertensive patients during antihypertensive therapy: the LIFE study.
abstract: BACKGROUND
  In the general population, blacks appear to have a higher risk of sudden cardiac death (SCD).
  
  
  OBJECTIVE
  To determine whether black hypertensive patients have a higher SCD incidence.
  
  
  METHODS
  The incidence of SCD was examined in 533 black and 8660 nonblack hypertensive patients with electrocardiographic left ventricular hypertrophy randomly assigned to losartan- or atenolol-based treatment.
  
  
  RESULTS
  During a mean follow-up of 4.8 ± 0.9 years, SCD occurred in 178 patients (1.9%); 5-year SCD incidence was significantly higher in black than in nonblack patients (3.9% vs 1.9%; P = .007). In univariate Cox analyses, black patients had a 97% higher risk of SCD (hazard ratio 1.97; 95% confidence interval 1.19-3.25; P = .015). In multivariate Cox analyses adjusting for randomized treatment, age, sex, body mass index, diabetes, history of heart failure, atrial fibrillation, myocardial infarction, ischemic heart disease, stroke, peripheral vascular disease, smoking, serum total and high-density lipoprotein cholesterol level, creatinine level, glucose level, and urine albumin/creatinine ratio and for incident myocardial infarction, in-treatment heart rate, QRS duration, diastolic and systolic pressure, Cornell voltage-duration product, and Sokolow-Lyon voltage left ventricular hypertrophy treated as time-varying covariates, black race remained associated with a 98% increased risk of SCD (hazard ratio 1.98; 95% confidence interval 1.12-3.59; P = .020).
  
  
  CONCLUSIONS
  Black hypertensive patients are at increased risk of SCD. The higher risk of SCD in black patients persists after adjusting for the higher prevalence of risk factors in black patients, in-treatment blood pressure, and the established predictive value of in-treatment electrocardiographic left ventricular hypertrophy and heart rate for SCD in this population.
authors.affiliation: Division of Cardiology, Weill Cornell Medical College, Cornell University, New York, New York 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: Stevo
authors.initials: S
authors.lastname: Julius
authors.forename: Björn
authors.initials: B
authors.lastname: Dahlöf
authors.forename: Richard B
authors.initials: RB
authors.lastname: Devereux
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D044383:Black People / Q000706:statistics & numerical data*; D016009:Chi-Square Distribution; D016001:Confidence Intervals; D016757:Death, Sudden, Cardiac / Q000453:epidemiology* / Q000208:ethnology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000453:epidemiology / Q000208:ethnology / Q000401:mortality*; D015994:Incidence; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D011446:Prospective Studies; D012306:Risk
chemical_list: D000959:Antihypertensive Agents