Effects of losartan on cardiovascular morbidity and mortality in patients with isolated systolic hypertension and left ventricular hypertrophy -: A Losartan Intervention For Endpoint Reduction (LIFE) substudy
Effects of losartan on cardiovascular morbidity and mortality in patients with isolated systolic hypertension and left ventricular hypertrophy -: A Losartan Intervention For Endpoint Reduction (LIFE) substudy
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DOI：
10.1001/jama.288.12.1491
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发表时间：
2002-09-25
影响因子：
120.7
通讯作者：
Wedel, H
中科院分区：
文献类型：
--
作者：
Kjeldsen, SE;Dahlöf, B;Wedel, H
背景安慰剂对照试验中的药物干预对单纯收缩期高血压有益。目的验证氯沙坦改善单纯收缩期高血压伴心电图左室肥厚（ECG LVH）患者预后优于阿替洛尔的假设。1995- 2001年进行的平行组研究。设置和参与者共1326名年龄在55岁至80岁之间的男性和女性（平均年龄70岁），收缩压160至200 mm Hg，舒张压低于90 mm Hg（平均174/83 mm Hg）和ECG-LVH，从北欧国家、英国、干预患者被随机分配接受氯沙坦（n =660）或阿替洛尔（n=666）每日一次，氢氯噻嗪作为两组的第二种药物，结果氯沙坦组和阿替洛尔组血压分别降低了28/9和28/9 mm Hg。与阿替洛尔相比，氯沙坦组的主要结局减少了25%，每1000患者年发生25.1 vs 35.4起事件（相对风险[RR]，0.75; 95%置信区间[CI]，0.56-1.01; P= 0.06，校正了ECG-LVH的风险和程度;未校正的RR，0.71; 95% CI，0.53-0.95; P= 0.02）。接受氯沙坦治疗的患者在以下方面有所降低，但心肌梗死的发生率无差异：（8.7 vs 16.9起事件/1000患者-年; RR，0.54; 95% CI，0.34-0.87; P= 0.01），非致死性和致死性卒中（10.6 vs 18.9起事件/1000患者-年; RR，0.60; 95% CI，0.38-0.92; P= 0.02），新发糖尿病（12.6 vs 20.1起事件/1000患者-年; RR，0.62; 95% CI，0.40-0.97; P，= 0.04）和总死亡率（21.2 vs 30.2起事件/1000患者-年; RR，0.72; 95% CI，0.53-1.00; P= 0.046）。洛沙坦降低ECG-LVH的作用优于阿替洛尔（P
Context Drug intervention in placebo-controlled trials has been beneficial in isolated systolic hypertension.Objective To test the hypothesis that losartan improves outcome better than atenolol in patients with isolated systolic hypertension and electrocardiographically documented left ventricular hypertrophy (ECG-LVH).Design Double-blind, randomized, parallel-group study conducted in 1995-2001.Setting and Participants A total of 1326 men and women aged 55 through 80 years (mean, 70 years) with systolic blood pressure of 160 to 200 mm Hg and diastolic blood pressure of less than 90 mm Hg (mean, 174/83 mm Hg) and ECG-LVH, recruited from 945 outpatient settings in the Nordic countries, the United Kingdom, and the United States.Interventions Patients were randomly assigned to receive once-daily losartan (n =660) or atenolol (n=666) with hydrochlorothiazide as the second agent in both arms, for a mean of 4.7 years.Main Outcome Measure Composite end point of cardiovascular death, stroke, or myocardial infarction.Results Blood pressure was reduced by 28/9 and 28/9 mm Hg in the losartan and atenolol arms. The main outcome was reduced by 25% with losartan compared with atenolol, 25.1 vs 35.4 events per 1000 patient-years (relative risk [RR], 0.75; 95% confidence interval [CI], 0.56-1.01; P=.06, adjusted for risk and degree of ECG-LVH; unadjusted RR, 0.71; 95% Cl, 0.53-0.95; P=.02). Patients receiving losartan had reductions in the following without a difference in the incidence of myocardial infarction: cardiovascular mortality (8.7 vs 16.9 events per 1000 patient-years; RR, 0.54; 95% Cl, 0.34-0.87; P=.01), nonfatal and fatal stroke (10.6 vs 18.9 events per 1000 patient-years; RR, 0.60; 95% Cl, 0.38-0.92; P=.02), new-onset diabetes (12.6 vs 20.1 events per 1000 patient-years; RR, 0.62; 95% Cl, 0.40-0.97; P,=.04), and total mortality (21.2 vs 30.2 events per 1000 patient-years; RR, 0.72; 95% Cl, 0.53-1.00; P=.046). Losartan decreased ECG-LVH,more than atenolol (P