The LIFE Study

Dahlöf, Björn; Devereux, Richard B.; Kjeldsen, Sverre E.; Julius, Stevo; Beevers, D. G.; Fairé, Ulf dé; Fyhrquist, F; Ibsen, Hans; Kristianson, Krister; Pedersen, Ole Lederballe; Lindholm, Lars; Nieminen, Markku S.; Omvik, Per; Oparil, Suzanne; Wedel, Hans; Edelman, Jonathan M.; Snapinn, Steve; Harris, Katherine E.; Gleim, Gilbert W.

doi:10.1016/b978-0-7216-0258-5.50121-6

Cited by 35 publications

(50 citation statements)

References 63 publications

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“…It is of interest that other studies that included hypertensive patients but used more homogeneous populations, from the point of view of the natural history of the disease, as reflected by the presence of a certain target organ disease (e.g., left ventricular hypertrophy, microalbuminuria) (14 -18,28,29,36, 37) or risk profile (12,21,27), originated more positive and meaningful results on primary end points (Figure 1). As a consequence, the focus of interventional trials probably should change and shift toward more clinically oriented targets.…”

Section: Head-to-head Mega-trials In Hypertensionmentioning

confidence: 99%

“…The Losartan Intervention for Endpoint Reduction in Hypertension (LIFE) Study (21) has strongly suggested benefits that go beyond BP reduction in hypertensive patients with left ventricular hypertrophy. In the presence of comparable BP reductions with a treatment regimen that is based on the ARB losartan versus a treatment regimen that is based on the ␤ blocker atenolol, the losartan-based treatment significantly reduced the risk for the primary combined endpoint of cardiovascular death, stroke, and acute myocardial infarction by 13% and the incidence of fatal and nonfatal stroke by 25% compared with atenolol in Ͼ9000 patients who were selected on the basis of the presence of essential hypertension and left ventricular hypertrophy.…”

Section: The Case Of Ras In Clinical Trials: Benefits Beyond Bp Control?mentioning

confidence: 99%

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Fewer Mega-Trials and More Clinically Oriented Studies in Hypertension Research? The Case of Blocking the Renin-Angiotensin-Aldosterone System

Volpe¹,

Pagannone²

2006

Journal of the American Society of Nephrology

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In recent years, medical practice has been influenced substantially by several factors, including the overwhelming development of evidence-based medicine, which is a consequence of the impressive, growing number of large clinical trials, the so-called "mega-trials." These clinical studies are designed mostly to investigate the effects of drugs or treatments on hard end points that cannot be tested by individual physicians in their daily clinical practice. The growing role of this epidemiologic approach to medicine, which is based mostly on the assessment of the average response or behavior of large populations rather than of individuals, is systematically replacing the former knowledge and reference points of the physician, as a substitute rather than as an aid. Taking into account the case of hypertension and particularly the renin-angiotensin system-blocking agents, this article reviews the issues and limitations of transferring evidence from mega-trials to clinical practice and suggests new strategies to make trials more effective and transferable to the case of individual patients.J Am Soc Nephrol 17: S36 -S43, 2006S36 -S43, . doi: 10.1681 I n the past two decades, medical practice has been influenced and modified substantially by several factors, including the overwhelming development of evidencebased medicine (EBM), which is a consequence of the impressive, growing number of large clinical trials, the socalled "mega-trials." These clinical studies are designed mostly to investigate the effects of drugs or treatments on hard end points, such as overall cardiovascular mortality, myocardial infarction, ischemic stroke, heart failure, ESRD, and, more in general, major prognostic outcomes, all items that cannot be tested by individual physicians in their daily clinical practice. The growing role of this epidemiologic approach to medicine, which is based mostly on the assessment of the average response or behavior of large population samples rather than of individuals, is systematically replacing the former knowledge and reference points of the physician, as a substitute rather than as an aid. Besides and beyond the personal clinical experience and professional skills and a sufficient knowledge of pathophysiologic mechanisms and pharmacologic drug properties, today each individual physician is required to be aware of the results of many trials and to transfer them to her or his clinical activity. Any significant deviation from the strict application of EBM to therapeutic management of the clinical cases may seem not to be justified.In fact, the results of large international trials are more and more perceived not as a valid basis for therapeutic decisions but rather as the only evidence that can validate a treatment or an intervention. As a consequence, doctors are becoming more prone to accept acritically the conclusions of a mega-trial (and sometimes also the results of a small, "well-published" trial) and to choose a specific and often life-long treatment, as the results suggest. This phenomenon often happen...

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Section: Head-to-head Mega-trials In Hypertensionmentioning

confidence: 99%

Section: The Case Of Ras In Clinical Trials: Benefits Beyond Bp Control?mentioning

confidence: 99%

Fewer Mega-Trials and More Clinically Oriented Studies in Hypertension Research? The Case of Blocking the Renin-Angiotensin-Aldosterone System

Volpe¹,

Pagannone²

2006

Journal of the American Society of Nephrology

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“…The use of cocaine, especially alkaloidal forms (crack) has been associated with a consistent increase in the risk of both ischemic and hemorrhagic stroke 405 .…”

Section: Illegal Drugsmentioning

confidence: 99%

Recommendations for Stroke Management: Update 2003

Demarin¹,

Lovrenčić-Huzjan²,

Trkanjec³

et al. 2004

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“…Now, beyond the fact that it is hard to say at this time whether this is better or more reliable than conventional ''office BP'', it is considered that this BP assessment may produce ''artificially lower BP'' ranging between 15 to 20 mmHg. This, in other words, would mean that the goal of less than 120 mmHg would more or less correspond to less than 140 mmHg and that the goal of less than 140 mmHg would correspond to approximately less than 160 mmHg adopted in the vast majority of recent randomized clinical trials in hypertension [17][18][19][20]. Indeed, Myers et al clearly demonstrated relevant differences between BP values obtained by automated devices and conventional measurements [21].…”

mentioning

confidence: 99%