ORLANDO — Hypertensive women experience significantly less regression of left ventricular hypertrophy than do men in response to equal pharmacologic lowering of blood pressure, yet their resultant reduction in cardiovascular events is just as great.
This new finding in a secondary analysis of the LIFE (Losartan Intervention for End Point Reduction in Hypertension) trial suggests that the optimal degree of left ventricular hypertrophy (LVH) regression for risk reduction in response to antihypertensive therapy is different in men and women, Dr. Peter M. Okin observed at the annual scientific sessions of the American Heart Association.
LIFE involved 9,193 hypertensive patients with ECG evidence of LVH, including 4,963 women. Participants were randomized to losartan- or atenolol-based antihypertensive therapy with as-needed hydrochlorothiazide to a target blood pressure of 140/90 mm Hg or less.
The primary results, demonstrating significantly better outcomes in the losartan arm, have previously been reported (Lancet 2002;359:995–1003).
In the new secondary analysis, unadjusted 5-year rates of MI, stroke, cardiovascular death, and a composite of the three end points were all significantly lower in women than men, regardless of treatment arm. (See chart.)
Yet women experienced less LVH regression: a mean 3.0-mm reduction in Sokolow-Lyon voltage from a baseline of 28.2 mm, compared with a 4.8-mm decrease from a baseline of 32.1 mm among men, according to Dr. Okin of Cornell University, New York.
Mean baseline blood pressure was 173/99 mm Hg in men and similar (175/97 mm Hg) in women. The men experienced a mean 30/18–mm Hg reduction in blood pressure with treatment, compared with a 29/17–mm Hg reduction in women.
In multivariate Cox regression analyses, women who experienced significant regression of LVH as reflected in a decrease in Sokolow-Lyon voltage equal to or greater than the median 3.0 mm had an adjusted 40% reduction in the relative risk of the composite of MI, stroke, and cardiovascular death. Men who equaled or exceeded the sex-specific median 4.5-mm decrease had a 32% risk reduction.
The LIFE study was supported by Merck & Co. Dr. Okin reported having no relevant financial conflicts.
VITALS
Source Elsevier Global Medical News