Population impact of losartan use on stroke in the European Union (EU): Projections from the Losartan Intervention For Endpoint reduction in hypertension (LIFE) study

Abstract

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 ¼ 0.021). The further reduction in stroke with losartan (RR 0.75, 95% CI 0.63-0.89, P ¼ 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.

Possible pathophysiologic mechanisms supporting the superior stroke protection of angiotensin receptor blockers compared to angiotensin-converting enzyme inhibitors: clinical and experimental evidence

“…Disability from stroke accounts for significant healthcare expenditures in the European Union as well, and these expenditures are also projected to rise in the future, since the incidence of stroke will increase with the aging of the population. 8 In an analysis of 11 major randomized intervention trials for the treatment of hypertension, stroke emerged as more common than myocardial infarction among hypertensive patients. 9 Possible causes for this increase in stroke are the ageing of the population and the poor control of hypertension.…”

Left Atrial Size and Risk of Major Cardiovascular Events During Antihypertensive Treatment

“…However, hypertensive patients with electrocardiographic signs of LV hypertrophy have been estimated at 7.8 million in the first 15 nations assembled in the European Union, 38 and nearly as many have been postulated both in Eastern Europe and in the United States.…”

Clusters of metabolic risk factors predict cardiovascular events in hypertension with target-organ damage: the LIFE study

“…Among the 9193 participants in the LIFE study, 24,25 we selected 8243 with body mass index (BMI) X20 kg/m 2 26 and available laboratory data needed to assess lipid and glucose profiles at enrolment. General information on recruitment of the LIFE cohort and characteristics of participants have been reported previously.…”