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Cardiovascular morbidity and mortality in hypertensive patients with a history of atrial fibrillation: The Losartan Intervention For End Point Reduction in Hypertension (LIFE) study.
J Am Coll Cardiol. 2005 Mar 01; 45(5):705-11.JACC

Abstract

OBJECTIVES

We assessed the impact of antihypertensive treatment in hypertensive patients with electrocardiographic (ECG) left ventricular (LV) hypertrophy and a history of atrial fibrillation (AF).

BACKGROUND

Optimal treatment of hypertensive patients with AF to reduce the risk of cardiovascular morbidity and mortality remains unclear.

METHODS

As part of the Losartan Intervention For End point reduction in hypertension (LIFE) study, 342 hypertensive patients with AF and LV hypertrophy were assigned to losartan- or atenolol-based therapy for 1,471 patient-years of follow-up.

RESULTS

The primary composite end point (cardiovascular mortality, stroke, and myocardial infarction) occurred in 36 patients in the losartan group versus 67 in the atenolol group (hazard ratio [HR] = 0.58, 95% confidence interval [CI] 0.39 to 0.88, p = 0.009). Cardiovascular deaths occurred in 20 versus 38 patients in the losartan and atenolol groups, respectively (HR = 0.58, 95% CI 0.33 to 0.99, p = 0.048). Stroke occurred in 18 versus 38 patients (HR = 0.55, 95% CI 0.31 to 0.97, p = 0.039), and myocardial infarction in 11 versus 8 patients (p = NS). Losartan-based treatment led to trends toward lower all-cause mortality (30 vs. 49, HR = 0.67, 95% CI 0.42 to 1.06, p = 0.090) and fewer pacemaker implantations (5 vs. 15, p = 0.065), whereas hospitalization for heart failure took place in 15 versus 26 patients and sudden cardiac death in 9 versus 17, respectively (both p = NS). The benefit of losartan was greater in patients with AF than those with sinus rhythm for the primary composite end point (p = 0.019) and cardiovascular mortality (p = 0.039).

CONCLUSIONS

Losartan is more effective than atenolol-based therapy in reducing the risk of the primary composite end point of cardiovascular morbidity and mortality as well as stroke and cardiovascular death in hypertensive patients with ECG LV hypertrophy and AF.

Authors+Show Affiliations

Department of Medicine, Glostrup University Hospital, Glostrup, Denmark. kristian@wachtell.netNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Multicenter Study
Randomized Controlled Trial

Language

eng

PubMed ID

15734614

Citation

Wachtell, Kristian, et al. "Cardiovascular Morbidity and Mortality in Hypertensive Patients With a History of Atrial Fibrillation: the Losartan Intervention for End Point Reduction in Hypertension (LIFE) Study." Journal of the American College of Cardiology, vol. 45, no. 5, 2005, pp. 705-11.
Wachtell K, Hornestam B, Lehto M, et al. Cardiovascular morbidity and mortality in hypertensive patients with a history of atrial fibrillation: The Losartan Intervention For End Point Reduction in Hypertension (LIFE) study. J Am Coll Cardiol. 2005;45(5):705-11.
Wachtell, K., Hornestam, B., Lehto, M., Slotwiner, D. J., Gerdts, E., Olsen, M. H., Aurup, P., Dahlöf, B., Ibsen, H., Julius, S., Kjeldsen, S. E., Lindholm, L. H., Nieminen, M. S., Rokkedal, J., & Devereux, R. B. (2005). Cardiovascular morbidity and mortality in hypertensive patients with a history of atrial fibrillation: The Losartan Intervention For End Point Reduction in Hypertension (LIFE) study. Journal of the American College of Cardiology, 45(5), 705-11.
Wachtell K, et al. Cardiovascular Morbidity and Mortality in Hypertensive Patients With a History of Atrial Fibrillation: the Losartan Intervention for End Point Reduction in Hypertension (LIFE) Study. J Am Coll Cardiol. 2005 Mar 1;45(5):705-11. PubMed PMID: 15734614.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cardiovascular morbidity and mortality in hypertensive patients with a history of atrial fibrillation: The Losartan Intervention For End Point Reduction in Hypertension (LIFE) study. AU - Wachtell,Kristian, AU - Hornestam,Björn, AU - Lehto,Mika, AU - Slotwiner,David J, AU - Gerdts,Eva, AU - Olsen,Michael H, AU - Aurup,Peter, AU - Dahlöf,Björn, AU - Ibsen,Hans, AU - Julius,Stevo, AU - Kjeldsen,Sverre E, AU - Lindholm,Lars H, AU - Nieminen,Markku S, AU - Rokkedal,Jens, AU - Devereux,Richard B, PY - 2004/01/26/received PY - 2004/06/09/accepted PY - 2005/3/1/pubmed PY - 2005/4/1/medline PY - 2005/3/1/entrez SP - 705 EP - 11 JF - Journal of the American College of Cardiology JO - J Am Coll Cardiol VL - 45 IS - 5 N2 - OBJECTIVES: We assessed the impact of antihypertensive treatment in hypertensive patients with electrocardiographic (ECG) left ventricular (LV) hypertrophy and a history of atrial fibrillation (AF). BACKGROUND: Optimal treatment of hypertensive patients with AF to reduce the risk of cardiovascular morbidity and mortality remains unclear. METHODS: As part of the Losartan Intervention For End point reduction in hypertension (LIFE) study, 342 hypertensive patients with AF and LV hypertrophy were assigned to losartan- or atenolol-based therapy for 1,471 patient-years of follow-up. RESULTS: The primary composite end point (cardiovascular mortality, stroke, and myocardial infarction) occurred in 36 patients in the losartan group versus 67 in the atenolol group (hazard ratio [HR] = 0.58, 95% confidence interval [CI] 0.39 to 0.88, p = 0.009). Cardiovascular deaths occurred in 20 versus 38 patients in the losartan and atenolol groups, respectively (HR = 0.58, 95% CI 0.33 to 0.99, p = 0.048). Stroke occurred in 18 versus 38 patients (HR = 0.55, 95% CI 0.31 to 0.97, p = 0.039), and myocardial infarction in 11 versus 8 patients (p = NS). Losartan-based treatment led to trends toward lower all-cause mortality (30 vs. 49, HR = 0.67, 95% CI 0.42 to 1.06, p = 0.090) and fewer pacemaker implantations (5 vs. 15, p = 0.065), whereas hospitalization for heart failure took place in 15 versus 26 patients and sudden cardiac death in 9 versus 17, respectively (both p = NS). The benefit of losartan was greater in patients with AF than those with sinus rhythm for the primary composite end point (p = 0.019) and cardiovascular mortality (p = 0.039). CONCLUSIONS: Losartan is more effective than atenolol-based therapy in reducing the risk of the primary composite end point of cardiovascular morbidity and mortality as well as stroke and cardiovascular death in hypertensive patients with ECG LV hypertrophy and AF. SN - 0735-1097 UR - https://www.unboundmedicine.com/medline/citation/15734614/Cardiovascular_morbidity_and_mortality_in_hypertensive_patients_with_a_history_of_atrial_fibrillation:_The_Losartan_Intervention_For_End_Point_Reduction_in_Hypertension__LIFE__study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735-1097(04)02399-X DB - PRIME DP - Unbound Medicine ER -