Regression of ECG-LVH is associated with lower risk of new-onset heart failure and mortality in patients with isolated systolic hypertension; The LIFE study.
BACKGROUND
Hypertension and electrocardiographic left ventricular hypertrophy (ECG-LVH) are strong predictors of heart failure (HF). It is unclear whether regression of ECG-LVH during treatment predicts less new-onset HF in patients with isolated systolic hypertension (ISH).


METHODS
A total of 9,027 patients with hypertension and ECG-LVH and without a history of HF were randomized to losartan- or atenolol-based treatment in the Losartan Intervention For Endpoint reduction in hypertension study. Incident HF and the combined endpoint of HF and death were evaluated in 1,280 ISH patients and as compared with 7,747 patients with systolic-diastolic hypertension or isolated diastolic hypertension (non-ISH) during mean 4.8 ± 0.9 years follow-up.


RESULTS
New-onset HF and HF or death occurred in 57 (4.5%) and 179 (14.0%) ISH patients and 220 (2.8%) and 787 (10.2%) non-ISH patients. In Cox regression analyses adjusting for treatment and HF risk factors, time-varying Cornell product was associated with lower risk of new-onset HF in ISH (adjusted hazard ratio (HR) 0.79, 95% confidence interval (CI) 0.67-0.94, P = 0.008, per 1,050 mm × ms (1 SD) lower Cornell product) and in non-ISH (adjusted HR 0.67, 95% CI 0.61-0.72, P < 0.001, per SD lower Cornell product). In parallel analyses, time-varying Cornell product was associated with lower risk of new-onset HF or death in ISH and non-ISH (adjusted HR 0.83, 95% CI 0.75-0.93, P = 0.001 and 0.82, 95% CI 0.77-0.87, P < 0.001, per SD lower Cornell product).


CONCLUSIONS
Regression of time-varying Cornell product was associated with similar reductions in risk of new-onset HF and the combined endpoint of HF or death in ISH and non-ISH patients.
Department of Cardiology, Oslo University Hospital, Norway. a.c.k.larstorp@medisin.uio.no
Anne Cecilie K
AC
Larstorp
Peter M
PM
Okin
Richard B
RB
Devereux
Michael H
MH
Olsen
Hans
H
Ibsen
Björn
B
Dahlöf
Sverre E
SE
Kjeldsen
Kristian
K
Wachtell
D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001262:Atenolol / Q000627:therapeutic use*; D005260:Female; D006333:Heart Failure / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000188:drug therapy*; D017379:Hypertrophy, Left Ventricular / Q000150:complications*; D019808:Losartan / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D016896:Treatment Outcome
D000959:Antihypertensive Agents; D001262:Atenolol; D019808:Losartan