Lowering of blood pressure and predictors of response in patients with left ventricular hypertrophy: The LIFE study

The Losartan Intervention For Endpoint (LIFE) reduction in hypertension stu dy is a double-blind, prospective, parallel-group study comparing the effec ts of losartan with those of atenolol on the reduction of cardiovascular co mplications in patients (n = 9,194) with essential hypertension and with el ectrocardiographically (ECG) documented left ventricular hypertrophy (LVH). Baseline blood pressure was 174.4/97.8 mm Hg (mean), age 66.9 years, body mass index 28.0 kg/m(2): 54.1% were women and 12.5% had diabetes mellitus. This population will be treated until at least 1040 have a primary endpoint . After five scheduled visits and 12 months of follow-up, blood pressure de creased by 23.9/12.8 mm Hg to 150.5/85.1 mm Hg (target < 140/90 mm Hg). The mandatory titration level of less than or equal to 160/95 mm Hg was reache d by 72.1% of the patients. At the 12-month visit, 22.7% of all patients we re taking blinded study drug alone, 44.3% were taking blinded drug plus hyd rochlorothiazide (HCTZ), and 17.7% were taking blinded drugs plus HCTZ and additional drugs. Controlling for all other variables, patients in the US r eceived more medication and had 2.4 times the odds of achieving blood press ure control than patients in the rest of the study (P < .001). Previously u ntreated patients (n = 2530) had a larger initial decrease in blood pressur e compared with those previously treated. Diabetics (n = 1148) needed more medication than nondiabetics to gain blood pressure control. Only 13.9% of the patients had discontinued blinded study drug and 1.4% missed the revisi t at 12 months. These data demonstrate both the successful lowering of blood pressure durin g 12 months of follow-up in a large cohort of patients with hypertension an d LVH on ECG, but also emphasize the need for two or more drugs to control high blood pressure in most of these patients. Being previously treated and having diabetes were associated with less blood pressure response, whereas living in the US indicated better blood pressure control. It has been poss ible to keep most of these patients with complicated hypertension taking bl inded study drug for 12 months. (C) 2000 American Journal of Hypertension, Ltd.