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Does albuminuria predict cardiovascular outcome on treatment with losartan versus atenolol in hypertension with left ventricular hypertrophy? A LIFE substudy.

Abstract：

OBJECTIVES:To examine a possible relationship between baseline albuminuria and effect of losartan versus atenolol on cardiovascular (CV) events in hypertensive patients with left ventricular hypertrophy, the effect of losartan versus atenolol on albuminuria, and whether the benefits of losartan versus atenolol could be explained by influence of losartan on albuminuria. DESIGN:Double-blind, randomized, controlled trial of 4.8 years. SETTING:Out-patient setting. PATIENTS:A total of 8206 with hypertension and left ventricular hypertrophy. INTERVENTIONS:Losartan or atenolol, supplemented with diuretics and/or calcium antagonists to reach blood pressure < 140/90 mmHg MAIN OUTCOME MEASURES:The urine albumin/creatinine ratio, and the primary composite endpoint (CEP) of CV death, myocardial infarction, and stroke. RESULTS:The blood pressure was reduced similarly on losartan (30.2/16.6 mmHg) versus atenolol (29.1/16.8 mmHg). The risk of a primary CEP increased linearly from the lowest to the highest decile of baseline albuminuria. The benefits of losartan versus atenolol for the primary CEP and for stroke tended to be more pronounced among patients above the median value for baseline albuminuria (urine albumin/creatinine ratio, 1.28 mg/mmol). The decrease in albuminuria was significantly greater with losartan versus atenolol throughout the study (a decrease from baseline to year 2 of 33% losartan versus 25% atenolol). One-fifth of the difference in favor of losartan on the primary CEP was explained by the greater reduction in albuminuria on losartan. CONCLUSIONS:Baseline albuminuria is a powerful risk factor for CV events. Baseline albuminuria did not identify the group of patients with greatest benefit on losartan versus atenolol in LIFE. Reduction in albuminuria explained one-fifth of the benefits of losartan versus atenolol.

journal_name

J Hypertens

journal_title

Journal of hypertension

authors

Ibsen H,Wachtell K,Olsen MH,Borch-Johnsen K,Lindholm LH,Mogensen CE,Dahlöf B,Devereux RB,de Faire U,Fyhrquist F,Julius S,Kjeldsen SE,Lederballe-Pedersen O,Nieminen MS,Omvik P,Oparil S,Wan Y,LIFE substudy.

doi

10.1097/00004872-200409000-00026

subject

Has Abstract

pub_date

2004-09-01 00:00:00

pages

1805-11

issue

eissn

0263-6352

issn

1473-5598

pii

00004872-200409000-00026

journal_volume

pub_type

临床试验,杂志文章,随机对照试验

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Does albuminuria predict cardiovascular outcome on treatment with losartan versus atenolol in hypertension with left ventricular hypertrophy? A LIFE substudy.