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J Am Coll Cardiol, 2005; 45:705-711, doi:10.1016/j.jacc.2004.06.080
© 2005 by the American College of Cardiology Foundation
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CLINICAL RESEARCH: LVH AND ARRHYTHMIAS

Cardiovascular morbidity and mortality in hypertensive patients with a history of atrial fibrillation

The Losartan Intervention For End point reduction in hypertension (LIFE) study

Kristian Wachtell, MD, PhD*,{dagger},*, Björn Hornestam, MD, PhD{ddagger}, Mika Lehto, MD§, David J. Slotwiner, MD, FACC{dagger}, Eva Gerdts, MD, PhD||, Michael H. Olsen, MD, PhD*, Peter Aurup, MD, Björn Dahlöf, MD, PhD, FACC{ddagger}, Hans Ibsen, MD*, Stevo Julius, MD, FACC#, Sverre E. Kjeldsen, MD, PhD, FACC**, Lars H. Lindholm, MD{dagger}{dagger}, Markku S. Nieminen, MD§, Jens Rokkedal, MD* and Richard B. Devereux, MD, FACC{dagger}

* Department of Medicine, Glostrup University Hospital, Glostrup, Denmark
{dagger} Division of Cardiology, Weill Medical College of Cornell University, New York, New York
{ddagger} Department of Medicine, Sahlgrenska University Hospital/Östra, Göteborg, Sweden
§ Department of Cardiology, Helsinki University Central Hospital, Helsinki, Finland
|| Department of Cardiology, Haukeland University Hospital, Bergen, Norway
Merck Research Laboratories, West Point, Pennsylvania
# Department of Medicine, University of Michigan, Ann Arbor, Michigan
** Department of Preventive Medicine, Umeå University Hospital, Umeå, Sweden
{dagger}{dagger} Department of Medicine, Ullevål University Hospital, Oslo, Norway

Manuscript received January 26, 2004; accepted June 9, 2004.

* Reprint requests and correspondence: Dr. Kristian Wachtell, Rigshospitalet, Department of Medicine B2142, 9 Blegdamsvej, DK-2100 Copenhagen, Denmark (Email: kristian{at}wachtell.net).

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.

Abbreviations and Acronyms
  AF = atrial fibrillation
  CI = confidence interval
  ECG = electrocardiographic
  HF = heart failure
  HR = hazard ratio
  LIFE = Losartan Intervention For End point reduction in hypertension study
  LV = left ventricular
  MI = myocardial infarction


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