NEW ORLEANS — Hypertensive patients at the extremes of body build have a markedly greater cardiovascular event rate than those who are of normal weight, Giovanni de Simoni, M.D., reported at the annual scientific sessions of the American Heart Association.
Dr. de Simoni of Federico II University, Naples, Italy, presented a secondary analysis of the double-blind multinational Losartan Intervention for Endpoint Reduction in Hypertension (LIFE) trial, in which 9,079 hypertensive individuals were randomized to losartan- or atenolol-based antihypertensive therapy and followed for 4–6 years.
The primary LIFE end point—a composite of cardiovascular death and nonfatal MI and stroke—occurred in 1,081 patients. The adjusted risk was 25% greater in the 2.2% of study participants who were thin—that is, with a body mass index of less than 20 kg/m
Similarly, after adjusting for age, gender, race, smoking status, diabetes, left ventricular hypertrophy, and other variables, the rate of the primary study end point was 17% greater in the 45% of LIFE participants who were overweight—that is, having a BMI of at least 25 and less than 30 kg/m
The differences in outcome based on body build were even more striking with respect to cardiovascular mortality, which occurred in 432 LIFE participants. The adjusted risk was 71% greater in thin patients and 80% greater in those with class II-III obesity than in normal-weight hypertensive patients.
Losartan-based therapy was associated with a highly significant 15% reduction in the primary composite end point relative to atenolol-based treatment, regardless of BMI category.
Results of this analysis underscore the necessity of particularly aggressive control of blood pressure and other cardiovascular risk factors in hypertensive patients at the extremes of body build distribution, Dr. de Simoni concluded.