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Predictors of cardiovascular events in patients with hypertension and left ventricular hypertrophy: the Losartan Intervention for Endpoint reduction in hypertension study.
Blood Press. 2009; 18(6):348-61.BP

Abstract

OBJECTIVE

We assessed readily available patient characteristics, including albuminuria (not included in traditional cardiovascular risk scores), as predictors of cardiovascular events in hypertension with left ventricular hypertrophy (LVH) and developed risk algorithms/scores for outcomes.

METHODS

The Losartan Intervention For Endpoint reduction in hypertension (LIFE) study compared effects of losartan-based versus atenolol-based therapy on cardiovascular events in 9193 patients with hypertension and LVH. Univariate and multivariate analyses identified baseline variables with significant impact on development of the primary composite endpoint (cardiovascular death, stroke and myocardial infarction) and its components. Multivariate analysis used a Cox regression model with stepwise selection process. Risk scores were developed from coefficients of risk factors from the multivariate analysis, validated internally using naïve and jack-knife procedures, checked for discrimination and calibration, and compared with Framingham coronary heart disease and other risk scores.

RESULTS

LIFE risk scores showed increasing endpoint rates with increasing quintile (first to fifth quintile, composite endpoint 2.8-26.7%, cardiovascular death 0.5-14.4%, stroke 1.2-11.3%, myocardial infarction 1.4-8.1%) and were confirmed with a jack-knife approach that adjusts for potentially optimistic bias. The Framingham coronary heart disease and other risk scores overestimated risk in lower risk patients and underestimated risk in higher risk patients, except for myocardial infarction.

CONCLUSION

A number of patient characteristics predicted cardiovascular events in patients with hypertension and LVH. Risk scores developed from these patient characteristics, including albuminuria, strongly predicted outcomes and may improve risk assessment of patients with hypertension and LVH and planning of clinical trials.

Authors+Show Affiliations

University of Oslo, Ullevaal Hospital, N-0407 Oslo, Norway. s.e.kjeldsen@medisin.uio.noNo 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 availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

20001655

Citation

Kjeldsen, Sverre E., et al. "Predictors of Cardiovascular Events in Patients With Hypertension and Left Ventricular Hypertrophy: the Losartan Intervention for Endpoint Reduction in Hypertension Study." Blood Pressure, vol. 18, no. 6, 2009, pp. 348-61.
Kjeldsen SE, Devereux RB, Hille DA, et al. Predictors of cardiovascular events in patients with hypertension and left ventricular hypertrophy: the Losartan Intervention for Endpoint reduction in hypertension study. Blood Press. 2009;18(6):348-61.
Kjeldsen, S. E., Devereux, R. B., Hille, D. A., Lyle, P. A., Dahlöf, B., Julius, S., Edelman, J. M., Snapinn, S. M., de Faire, U., Fyhrquist, F., Ibsen, H., Lederballe-Pedersen, O., Lindholm, L. H., Nieminen, M. S., Omvik, P., Oparil, S., & Wedel, H. (2009). Predictors of cardiovascular events in patients with hypertension and left ventricular hypertrophy: the Losartan Intervention for Endpoint reduction in hypertension study. Blood Pressure, 18(6), 348-61. https://doi.org/10.3109/08037050903460590
Kjeldsen SE, et al. Predictors of Cardiovascular Events in Patients With Hypertension and Left Ventricular Hypertrophy: the Losartan Intervention for Endpoint Reduction in Hypertension Study. Blood Press. 2009;18(6):348-61. PubMed PMID: 20001655.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Predictors of cardiovascular events in patients with hypertension and left ventricular hypertrophy: the Losartan Intervention for Endpoint reduction in hypertension study. AU - Kjeldsen,Sverre E, AU - Devereux,Richard B, AU - Hille,Darcy A, AU - Lyle,Paulette A, AU - Dahlöf,Björn, AU - Julius,Stevo, AU - Edelman,Jonathan M, AU - Snapinn,Steven M, AU - de Faire,Ulf, AU - Fyhrquist,Frej, AU - Ibsen,Hans, AU - Lederballe-Pedersen,Ole, AU - Lindholm,Lars H, AU - Nieminen,Markku S, AU - Omvik,Per, AU - Oparil,Suzanne, AU - Wedel,Hans, PY - 2009/12/17/entrez PY - 2009/12/17/pubmed PY - 2010/2/26/medline SP - 348 EP - 61 JF - Blood pressure JO - Blood Press VL - 18 IS - 6 N2 - OBJECTIVE: We assessed readily available patient characteristics, including albuminuria (not included in traditional cardiovascular risk scores), as predictors of cardiovascular events in hypertension with left ventricular hypertrophy (LVH) and developed risk algorithms/scores for outcomes. METHODS: The Losartan Intervention For Endpoint reduction in hypertension (LIFE) study compared effects of losartan-based versus atenolol-based therapy on cardiovascular events in 9193 patients with hypertension and LVH. Univariate and multivariate analyses identified baseline variables with significant impact on development of the primary composite endpoint (cardiovascular death, stroke and myocardial infarction) and its components. Multivariate analysis used a Cox regression model with stepwise selection process. Risk scores were developed from coefficients of risk factors from the multivariate analysis, validated internally using naïve and jack-knife procedures, checked for discrimination and calibration, and compared with Framingham coronary heart disease and other risk scores. RESULTS: LIFE risk scores showed increasing endpoint rates with increasing quintile (first to fifth quintile, composite endpoint 2.8-26.7%, cardiovascular death 0.5-14.4%, stroke 1.2-11.3%, myocardial infarction 1.4-8.1%) and were confirmed with a jack-knife approach that adjusts for potentially optimistic bias. The Framingham coronary heart disease and other risk scores overestimated risk in lower risk patients and underestimated risk in higher risk patients, except for myocardial infarction. CONCLUSION: A number of patient characteristics predicted cardiovascular events in patients with hypertension and LVH. Risk scores developed from these patient characteristics, including albuminuria, strongly predicted outcomes and may improve risk assessment of patients with hypertension and LVH and planning of clinical trials. SN - 1651-1999 UR - https://www.unboundmedicine.com/medline/citation/20001655/Predictors_of_cardiovascular_events_in_patients_with_hypertension_and_left_ventricular_hypertrophy:_the_Losartan_Intervention_for_Endpoint_reduction_in_hypertension_study_ L2 - https://www.tandfonline.com/doi/full/10.3109/08037050903460590 DB - PRIME DP - Unbound Medicine ER -