Dahlöf B, Devereux R B, Julius S, Kjeldsen S E, Beevers G, de Faire U, Fyhrquist F, Hedner T, Ibsen H, Kristianson K, Lederballe-Pedersen O, Lindholm L H, Nieminen M S, Omvik P, Oparil S, Wedel H
Sahlgrenska University Hospital/Ostra, Göteborg, Sweden.
Hypertension. 1998 Dec;32(6):989-97. doi: 10.1161/01.hyp.32.6.989.
-Losartan was the first available orally administered selective antagonist of the angiotensin II type 1 receptor developed for the treatment of hypertension. The Losartan Intervention For Endpoint (LIFE) Reduction in Hypertension Study is a double-blind, prospective, parallel group study designed to compare the effects of losartan with those of the beta-blocker atenolol on the reduction of cardiovascular morbidity and mortality. Patients with essential hypertension, aged between 55 and 80 years, and ECG-documented left ventricular hypertrophy (LVH) were included. Altogether, 9223 patients in Scandinavia, the United Kingdom, and the United States were randomized from June 1995 through April 1997, and 9194 remain after exclusion of a study center at which irregularities were discovered. This population of hypertensives (mean systolic/diastolic blood pressure, 174.4/97.8 mm Hg) with LVH comprises women (54.1%) and men, mostly retired from active work (mean age, 66.9 years), with a high prevalence of overweight (mean body mass index, 28.0 kg/m2), diabetes mellitus (12.3%), lipid disorders (18.0%), and symptoms or signs of coronary heart disease (15.1%). There were fewer current smokers (<17%) than in the general population, and approximately 7% were nonwhite. Almost 30% of participants had been untreated for at least 6 months when screened for the study. Only 1557 persons who entered the placebo run-in period of 14 days were excluded, predominantly because of sitting blood pressures above or below the predetermined range of 160-200/95-115 mm Hg and ECG-LVH criteria not met. By application of simple 12-lead ECG criteria for LVH (Cornell voltage QRS duration product formula plus Sokolow-Lyon voltage read by a core laboratory), hypertensive patients with LVH with an average 5-year coronary heart disease risk of 22.3% according to the Framingham score were identified. This population is now being treated (goal, <140/90 mm Hg) in adherence with the protocol for at least 4 years after final enrollment (ie, through April 2001) and until at least 1040 patients suffer myocardial infarction, stroke, or cardiovascular death.
氯沙坦是首个可口服的血管紧张素II 1型受体选择性拮抗剂，用于治疗高血压。氯沙坦干预终点（LIFE）高血压降低研究是一项双盲、前瞻性、平行组研究，旨在比较氯沙坦与β受体阻滞剂阿替洛尔在降低心血管发病率和死亡率方面的效果。纳入年龄在55至80岁之间、有心电图记录的左心室肥厚（LVH）的原发性高血压患者。1995年6月至1997年4月，斯堪的纳维亚、英国和美国的9223名患者被随机分组，在排除一个发现有违规行为的研究中心后，还剩下9194名患者。这群患有LVH的高血压患者（平均收缩压/舒张压为174.4/97.8 mmHg）包括女性（54.1%）和男性，大多已从工作岗位退休（平均年龄66.9岁），超重患病率高（平均体重指数28.0 kg/m2），患有糖尿病（12.3%）、脂质紊乱（18.0%）以及有冠心病症状或体征（15.1%）。目前吸烟者比普通人群少（<17%），约7%为非白人。近30%的参与者在接受研究筛查时至少6个月未接受治疗。只有1557名进入14天安慰剂导入期的人被排除，主要原因是坐位血压高于或低于160 - 200/95 - 115 mmHg的预定范围以及未达到心电图LVH标准。通过应用简单的12导联心电图LVH标准（康奈尔电压QRS波时限乘积公式加上由核心实验室读取的索科洛 - 里昂电压），根据弗雷明汉评分，识别出平均5年冠心病风险为22.3%的LVH高血压患者。这群患者目前正在按照方案接受治疗（目标为<140/90 mmHg），在最终入组后至少4年（即到2001年4月），直到至少1040名患者发生心肌梗死、中风或心血管死亡。
