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Cardiovascular risk reduction in hypertensive black patients with left ventricular hypertrophy: the LIFE study

Stevo Julius1, Michael H Alderman, Gareth Beevers

  • 1Department of Internal Medicine, Division of Hypertension, University of Michigan Medical Center, 3918 Taubman Center, Ann Arbor, MI 48109-0356, USA. sjulius@umich.edu

Journal of the American College of Cardiology
|March 19, 2004
PubMed

Insights

Black patients with hypertension and left ventricular hypertrophy (LVH) may not benefit as much from losartan compared to atenolol. This subanalysis suggests losartan may not be a preferred first-line treatment for this demographic.

Area of Science:

  • Cardiology
  • Pharmacology
  • Hypertension Research

Background:

  • The Losartan Intervention For Endpoint reduction in hypertension (LIFE) study investigated losartan vs. atenolol in 9,193 hypertensive patients with left ventricular hypertrophy (LVH).
  • Overall, losartan reduced the primary composite endpoint (cardiovascular death, stroke, myocardial infarction) by 13% (p=0.021) with comparable blood pressure (BP) reduction to atenolol.
  • A potential interaction between ethnic background and treatment efficacy was suggested (p=0.057).

Purpose of the Study:

  • To conduct a subanalysis of the LIFE study focusing on the effects of losartan and atenolol on cardiovascular events specifically in black patients.
  • To explore potential differences in treatment response between black and non-black hypertensive patients with LVH.

Main Methods:

  • Exploratory analyses categorized LIFE study participants into black (n=533) and non-black (n=8,660) groups.
  • Further stratification was performed for U.S. patients: African American (n=523) and non-black (n=1,184).

Main Results:

  • A significant interaction between race (black/non-black) and treatment was observed (p=0.005).
  • The hazard ratio for the primary endpoint favored atenolol in black patients (HR=1.666, p=0.033) but favored losartan in non-black patients (HR=0.829, p=0.003).
  • In black patients, BP reduction was similar between groups, though losartan showed greater regression of electrocardiographic-LVH.

Conclusions:

  • The subanalysis generates a hypothesis that black patients with hypertension and LVH may not achieve similar cardiovascular outcome benefits with losartan-based treatment compared to non-black patients.
  • Findings do not support the use of losartan as a first-line treatment for cardiovascular outcomes in this specific patient population.
  • The subanalysis is limited by a relatively small number of cardiovascular events in the black patient subgroup.
Abstract

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