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Racial differences in incident heart failure during antihypertensive therapy
Peter M Okin1, Sverre E Kjeldsen, Björn Dahlöf
1Division of Cardiology, Weill Cornell Medical College, New York, NY 10065, USA. pokin@med.cornell.edu
Insights
Black patients with hypertension have a significantly higher risk of developing heart failure (HF) compared to non-black patients. This increased risk for heart failure persists even after accounting for other risk factors and treatments.
Area of Science:
- Cardiology
- Hypertension Research
- Racial Disparities in Health
Background:
- Black individuals exhibit a higher prevalence of heart failure (HF) compared to non-black individuals, potentially due to a greater burden of HF risk factors like hypertension.
- While HF incidence is notably higher in black individuals during long-term follow-up of young adults, the specific relationship between incident HF and race in treated hypertensive patients remains unclear.
Purpose of the Study:
- To investigate the relationship between race and the incidence of heart failure (HF) in hypertensive patients receiving treatment.
- To determine if the higher incidence of HF in black patients persists after adjusting for various clinical factors and treatments.
Main Methods:
- A cohort of 497 black and 8199 non-black hypertensive patients without a history of HF were analyzed.
- Patients were randomly assigned to losartan- or atenolol-based treatment regimens.
- Cox multivariate analyses were performed, adjusting for treatment, demographics, baseline ECG, HF risk factors, incident myocardial infarction, and time-varying covariates like blood pressure and left ventricular hypertrophy (LVH) indicators.
Main Results:
- Over a mean follow-up of 4.7 years, 265 patients (3.0%) were hospitalized for HF.
- The 5-year incidence of HF was significantly higher in black patients (7.0%) compared to non-black patients (3.1%, P<0.001).
- Black race was independently associated with a 130% increased risk of developing new HF (HR 2.30, 95% CI 1.24-4.28) after comprehensive adjustments.
Conclusions:
- Incident heart failure (HF) is substantially more common in black hypertensive patients than in non-black hypertensive patients.
- The elevated risk of new HF in black individuals is persistent and independent of HF risk factors, treatment effects, in-treatment blood pressure, and ECG markers of left ventricular hypertrophy (LVH).
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.
Methods And 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.
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