Dahlöf B, Burke T A, Krobot K, Carides G W, Edelman J M, Devereux R B, Diener H-C
Sahlgrenska University Hospital/Ostra, Göteborg, Sweden.
J Hum Hypertens. 2004 Jun;18(6):367-73. doi: 10.1038/sj.jhh.1001710.
The Losartan Intervention for Endpoint reduction in hypertension (LIFE) study was designed to compare losartan- vs atenolol-based antihypertensive treatment on cardiovascular morbidity and mortality in a population of 9193 hypertensive patients with left ventricular hypertrophy (LVH). In LIFE, the losartan-based treatment further reduced the primary composite end point (cardiovascular death, myocardial infarction, or stroke) by 13% (risk reduction (RR) 0.87, 95% confidence interval (CI) 0.77-0.98, P=0.021). The further reduction in stroke with losartan (RR 0.75, 95% CI 0.63-0.89, P=0.001) was the major contributing factor to the reduction in the primary end point. Our objective was to project the reduction in stroke observed with a losartan- vs an atenolol-based antihypertensive treatment regimen in the LIFE study to the European Union (EU) population. The number of stroke events averted was estimated by identifying the number of persons in the EU expected to meet the LIFE inclusion criteria, and multiplying this figure by the cumulative incidence risk difference in stroke from LIFE at 5.5 years. The age- and gender-specific prevalence of hypertension, electrocardiographically (ECG)-diagnosed LVH among those with hypertension (inclusion criteria), and heart failure among those with LVH and hypertension (exclusion criteria) were applied to the EU census estimates. We conservatively projected that an estimated 7.8 million individuals aged 55-80 years in the EU are affected by hypertension and ECG-diagnosed LVH. Use of a losartan-based antihypertensive treatment in this population is projected to prevent approximately 125 000 first strokes over a 5.5-year period. A population-wide prevention strategy of using losartan in patients with LVH and hypertension has the potential to have a major public health impact by reducing the morbidity and mortality of stroke in the EU.
氯沙坦降低高血压终点事件（LIFE）研究旨在比较以氯沙坦和阿替洛尔为基础的降压治疗对9193例伴有左心室肥厚（LVH）的高血压患者心血管发病率和死亡率的影响。在LIFE研究中，以氯沙坦为基础的治疗使主要复合终点（心血管死亡、心肌梗死或中风）进一步降低了13%（风险降低（RR）0.87，95%置信区间（CI）0.77 - 0.98，P = 0.021）。氯沙坦使中风进一步减少（RR 0.75，95% CI 0.63 - 0.89，P = 0.001）是主要复合终点降低的主要促成因素。我们的目标是将LIFE研究中观察到的以氯沙坦和阿替洛尔为基础的降压治疗方案在中风减少方面的效果推算到欧盟（EU）人群。通过确定欧盟中预计符合LIFE纳入标准的人数，并将该数字乘以LIFE研究中5.5年时中风的累积发病率风险差异，来估计避免的中风事件数量。将高血压的年龄和性别特异性患病率、高血压患者中经心电图（ECG）诊断的LVH（纳入标准）以及LVH和高血压患者中的心力衰竭（排除标准）应用于欧盟人口普查估计数。我们保守估计，欧盟有780万年龄在55 - 80岁的个体受高血压和经ECG诊断的LVH影响。预计在该人群中使用以氯沙坦为基础的降压治疗在5.5年期间可预防约12.5万例首次中风。在LVH和高血压患者中使用氯沙坦的全人群预防策略有可能通过降低欧盟中风的发病率和死亡率对公共卫生产生重大影响。
