Impact of Losartan on Stroke Risk in Hypertensive Patients in Primary Care
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Background and objective: While a number of conditions and risk factors that increase stroke risk have been identified, arterial hypertension is the most consistent and powerful predictor. The angiotensin II type 1 receptor antagonist (angiotensin receptor blocker [ARB]) losartan has been shown in the LIFE (Losartan Intervention for Endpoint Reduction in Hypertension) study to decrease stroke risk in hypertensive patients to a substantially greater extent than conventional therapy. We aimed to assess the impact of the blood pressure-lowering effect of losartan therapy on stroke risk in hypertensive patients in primary care.
Methods: A total of 2977 primary-care practices throughout Germany included 22 499 consecutive unselected patients with a confirmed diagnosis of hypertension in an open-label, prospective, observational study. In addition to demographics, known risk factors for stroke were documented on standardised questionnaires. The 10-year predicted risk of first stroke was calculated according to the Framingham Stroke Risk Score at baseline and after a mean of 94 ± 24 days of losartan (± hydrochlorothiazide [HCTZ]) therapy.
Results: The mean patient age was 64.1 ± 10.6 years, and 52.4% were males. Mean systolic/diastolic blood pressure decreased from 160 ± 15/93 ± 9mm Hg at baseline by −21 ± 14/−11 ± 9mm Hg. Besides hypertension, 84.9% of patients had other co-morbidities, of which the most frequent were hypercholesterolaemia (53.0%), diabetes mellitus (36.1%), coronary heart disease (31.1%) and left ventricular hypertrophy (24.2%). The average predicted 10-year stroke risk was 28.0 ± 21.9% at baseline, and 22.1 ± 19.5% at study end (relative risk reduction 24 ± 16%, p < 0.05). In subgroups of patients with diabetes or nephropathy, similar effects were noted. Drug-related adverse events were reported in 18 patients; all of these were non-serious.
Conclusion: Because of the high prevalence of co-morbidities and risk factors, the hypertensive patient population observed in this study presented with a high 10-year stroke risk. Treatment with losartan (± HCTZ) was well tolerated and led to a substantial decrease in blood pressure and associated stroke risk.
KeywordsLosartan Stroke Risk HCTZ Calcium Channel Antagonist Total Cohort
This study was presented at the Fifteenth European Hypertension Meeting on Hypertension in Milan, Italy, on 17 June 2005. The study was supported by an unrestricted educational grant from MSD Sharp & Dohme GmbH and Chibropharm GmbH, Haar/Munich, Germany.
Dr Bestehorn is an employee of MSD, and is also affiliated with the Medical Faculty of the Technical University of Dresden, Germany. Dr Wahle has no conflicts of interest that are directly relevant to the content of this study. The authors acknowledge the input of D. Pittrow, MD, PhD, Dresden/Munich, to the interpretation of the study.
- 6.Institut für Praxisforschung (PRAFO) im BDA [online]. Available from: http://www.hausarzt-bda.de/private/020/040/pravo.html [Accessed 2006 Jul 12]