Outcomes of Antihypertensive Therapy Vary for Men vs. Women

ORLANDO — Hypertensive women experience significantly less regression of left ventricular hypertrophy than do men in response to equal pharmacologic lowering of blood pressure, yet their resultant reduction in cardiovascular events is just as great.

This new finding in a secondary analysis of the LIFE (Losartan Intervention for End Point Reduction in Hypertension) trial suggests that the optimal degree of left ventricular hypertrophy (LVH) regression is different in men and women, Dr. Peter M. Okin observed at the annual scientific sessions of the American Heart Association.

LIFE involved 9,193 hypertensive patients with ECG evidence of LVH, including 4,963 women. Participants were randomized to losartan- or atenolol-based antihypertensive therapy with as-needed hydrochlorothiazide to a target blood pressure of 140/90 mm Hg or less. The primary results showed significantly better outcomes in the losartan arm (Lancet 2002;359:995–1003).

In the new secondary analysis, unadjusted 5-year rates of MI, stroke, cardiovascular death, and a composite of the three end points were all significantly lower in women than men, regardless of treatment arm. (See box.)

Yet women experienced less LVH regression: a mean 3.0-mm reduction in Sokolow-Lyon voltage from a baseline of 28.2 mm, compared with a 4.8-mm decrease from a baseline of 32.1 mm among men, according to Dr. Okin of Cornell University, New York.

Mean baseline blood pressure was 173/99 mm Hg in men and 175/97 mm Hg in women. The men had a mean 30/18–mm Hg reduction in blood pressure, compared with 29/17 mm Hg in women.

The LIFE study was supported by Merck & Co. Dr. Okin reported having no relevant financial conflicts.

Elsevier Global Medical News