Correlates of pulse pressure reduction during antihypertensive treatment ( losartan or atenolol) in hypertensive patients with electrocardiographic left ventricular hypertrophy (the LIFE study)

• Published in: The American journal of cardiology Vol. 89; no. 4; pp. 399 - 402
• Main Authors: Gerdts, Eva, Papademetriou, Vasilios, Palmieri, Vittorio, Boman, Kurt, Björnstad, Hans, Wachtell, Kristian, Giles, Thomas D, Dahlöf, Björn, Devereux, Richard B
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 15-02-2002; Elsevier; Elsevier Limited
• Subjects: Aged; Aged, 80 and over; Albumins - metabolism; Antihypertensive agents; Antihypertensive Agents - pharmacology; Antihypertensive Agents - therapeutic use; Atenolol - pharmacology; Atenolol - therapeutic use; Biological and medical sciences; Blood Pressure - drug effects; Cardiovascular disease; Cardiovascular system; Creatinine - urine; Drug therapy; Electrocardiography; Female; Humans; Hypertension; Hypertension - complications; Hypertension - drug therapy; Hypertension - physiopathology; Hypertrophy, Left Ventricular - complications; Losartan - pharmacology; Losartan - therapeutic use; Male; Medical research; Medical sciences; Middle Aged; Pharmacology. Drug treatments; Pulse; Randomized Controlled Trials as Topic; Human; Hypertension; Prognosis; Pulse; Clinical form; Cardiovascular disease; Non peptide compound; Atenolol; Left ventricle; Electrodiagnosis; Chemotherapy; Treatment; Biphenyl derivatives; Heart disease; Losartan; Electrocardiography; Antihypertensive agent; Arterial pressure; Angiotensin antagonist; Beta blocking agent; Hypertrophy
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/S0002-9149(01)02260-3

In hypertensive patients, pulse pressure has been related to hypertension-induced target organ damage and risk of cardiovascular events. However, correlates of pulse pressure reduction during antihypertensive treatment have been less extensively investigated. We related pulse pressure changes to clinical and echocardiographic findings before and after 2 years of antihypertensive treatment in 767 patients aged 55 to 80 years (mean 66) in the Losartan Intervention For End point reduction in hypertension study. Over 2 years, blood pressure and pulse pressure were reduced from 173/98 to 147/84 mm Hg and from 75 to 63 mm Hg, respectively, both p <0.001. In linear multivariate analysis controlling for initial pulse pressure, 2-year reduction in pulse pressure correlated negatively with age and concomitant diabetes mellitus, and positively with body height and 2-year reduction in mean blood pressure (multiple R
2 = 0.42, p <0.01). When dividing the study population into 2 groups using a prognostically validated partition for pulse pressure, patients with pulse pressure ≥63 mm Hg after 2 years of antihypertensive treatment (n = 349) were older and shorter, included more women and patients with isolated systolic hypertension, diabetes mellitus, albuminuria, and echocardiographic left ventricular hypertrophy at baseline, and also had a smaller decrease in mean blood pressure and the urinary albumin/creatinine ratio over 2 years (all p <0.05). Thus, in hypertensive patients with electrocardiographic left ventricular hypertrophy, older age, less reduction in mean blood pressure, concomitant diabetes mellitus, and shorter stature are associated with attenuated pulse pressure reduction during antihypertensive treatment.