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Cardiovascular morbidity and mortality in hypertensive patients with lower versus higher risk: a LIFE substudy

Stanley S Franklin1, Kristian Wachtell, Vasilios Papademetriou

  • 1Heart Disease Prevention Program, University of California, Irvine, CA 92697, USA. ssfranklinmd@earthlink.net

Hypertension (Dallas, Tex. : 1979)
|August 24, 2005
PubMed

Insights

Losartan demonstrated superiority over atenolol in reducing stroke, new-onset diabetes, and atrial fibrillation in both lower-risk and higher-risk patient groups. These benefits were observed independently of significant blood pressure reduction.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Trials

Background:

  • The Losartan Intervention For Endpoint reduction (LIFE) trial compared losartan and atenolol in hypertensive patients.
  • A substudy aimed to evaluate treatment efficacy in distinct patient risk groups.
  • Understanding differential drug effects based on patient risk stratification is crucial for personalized medicine.

Purpose of the Study:

  • To test the hypothesis that losartan is superior to atenolol in reducing cardiovascular events in lower-risk (LRG) versus higher-risk (HRG) patients.
  • To assess treatment effects independently of blood pressure reduction.
  • To analyze outcomes in predefined lower-risk and higher-risk patient cohorts.

Main Methods:

  • Post hoc analysis of the LIFE trial data.
  • Patients were categorized into LRG (no prior cardiovascular disease, no diabetes, no isolated systolic hypertension, lowest LVH quartiles) and HRG.
  • Hazard ratios (HR) and 95% confidence intervals (CI) were calculated for various endpoints.

Main Results:

  • In the LRG, losartan reduced stroke (HR 0.72), new-onset diabetes (HR 0.74), and new-onset atrial fibrillation (HR 0.69) compared to atenolol.
  • In the HRG, losartan reduced composite endpoints (HR 0.82), cardiovascular mortality (HR 0.77), stroke (HR 0.75), new-onset diabetes (HR 0.76), and new-onset atrial fibrillation (HR 0.71).
  • Losartan showed a slightly greater systolic blood pressure reduction in the LRG (-1.8 mm Hg) and HRG (-0.7 mm Hg) versus atenolol.

Conclusions:

  • Losartan, compared to atenolol, effectively reduces the risk of stroke, new-onset diabetes, and new-onset atrial fibrillation in both lower-risk and higher-risk hypertensive patients.
  • The observed benefits of losartan extend beyond blood pressure reduction.
  • Treatment choice may be influenced by patient risk stratification for optimal cardiovascular event prevention.

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