氯沙坦干预降低高血压终点事件研究（LIFE）中的心血管发病率和死亡率：一项与阿替洛尔对比的随机试验。

Cardiovascular morbidity and mortality in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol.

作者信息

Dahlöf Björn, Devereux Richard B, Kjeldsen Sverre E, Julius Stevo, Beevers Gareth, de Faire Ulf, Fyhrquist Frej, Ibsen Hans, Kristiansson Krister, Lederballe-Pedersen Ole, Lindholm Lars H, Nieminen Markku S, Omvik Per, Oparil Suzanne, Wedel Hans

机构信息

Sahlgrenska University Hospital/Ostra, Gothenburg, Swede.

出版信息

Lancet. 2002 Mar 23;359(9311):995-1003. doi: 10.1016/S0140-6736(02)08089-3.

DOI:10.1016/S0140-6736(02)08089-3

PMID:11937178

Abstract

BACKGROUND

Blood pressure reduction achieved with beta-blockers and diuretics is the best recorded intervention to date for prevention of cardiovascular morbidity and death in patients with hypertension. Left ventricular hypertrophy (LVH) is a strong independent indicator of risk of cardiovascular morbidity and death. We aimed to establish whether selective blocking of angiotensin II improves LVH beyond reducing blood pressure and, consequently, reduces cardiovascular morbidity and death.

METHODS

We did a double-masked, randomised, parallel-group trial in 9193 participants aged 55-80 years with essential hypertension (sitting blood pressure 160-200/95-115 mm Hg) and LVH ascertained by electrocardiography (ECG). We assigned participants once daily losartan-based or atenolol-based antihypertensive treatment for at least 4 years and until 1040 patients had a primary cardiovascular event (death, myocardial infarction, or stroke). We used Cox regression analysis to compare regimens.

FINDINGS

Blood pressure fell by 30.2/16.6 (SD 18.5/10.1) and 29.1/16.8 mm Hg (19.2/10.1) in the losartan and atenolol groups, respectively. The primary composite endpoint occurred in 508 losartan (23.8 per 1000 patient-years) and 588 atenolol patients (27.9 per 1000 patient-years; relative risk 0.87, 95% CI 0.77-0.98, p=0.021). 204 losartan and 234 atenolol patients died from cardiovascular disease (0.89, 0.73-1.07, p=0.206); 232 and 309, respectively, had fatal or non-fatal stroke (0.75, 0.63-0.89, p=0.001); and myocardial infarction (non-fatal and fatal) occurred in 198 and 188, respectively (1.07, 0.88-1.31, p=0.491). New-onset diabetes was less frequent with losartan. Interpretation Losartan prevents more cardiovascular morbidity and death than atenolol for a similar reduction in blood pressure and is better tolerated. Losartan seems to confer benefits beyond reduction in blood pressure.

摘要

背景

β受体阻滞剂和利尿剂实现的血压降低是迄今为止预防高血压患者心血管疾病发病率和死亡的最佳记录干预措施。左心室肥厚（LVH）是心血管疾病发病率和死亡风险的一个强有力的独立指标。我们旨在确定血管紧张素II的选择性阻断是否能在降低血压之外改善LVH，从而降低心血管疾病的发病率和死亡。

方法

我们对9193名年龄在55 - 80岁、患有原发性高血压（坐位血压160 - 200/95 - 115 mmHg）且通过心电图（ECG）确定有LVH的参与者进行了一项双盲、随机、平行组试验。我们为参与者分配基于氯沙坦或阿替洛尔的每日一次降压治疗，至少持续4年，直至1040名患者发生原发性心血管事件（死亡、心肌梗死或中风）。我们使用Cox回归分析来比较治疗方案。

结果

氯沙坦组和阿替洛尔组的血压分别下降了30.2/16.6（标准差18.5/10.1）和29.1/16.8 mmHg（19.2/10.1）。主要复合终点事件在508名氯沙坦组患者（每1000患者年23.8例）和588名阿替洛尔组患者中发生（每1000患者年27.9例；相对风险0.87，95%置信区间0.77 - 0.98，p = 0.021）。204名氯沙坦组和234名阿替洛尔组患者死于心血管疾病（0.89，0.73 - 1.07，p = 0.206）；分别有232名和309名患者发生致命或非致命性中风（0.75，0.63 - 0.89，p = 0.001）；心肌梗死（非致命性和致命性）分别发生在198名和188名患者中（1.07，0.88 - 1.31，p = 0.491）。氯沙坦组新发糖尿病的发生率较低。解读：在血压降低相似的情况下，氯沙坦比阿替洛尔预防更多的心血管疾病发病率和死亡，且耐受性更好。氯沙坦似乎在降低血压之外还能带来益处。