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(Circulation. 2005;111:1924-1931.)
© 2005 American Heart Association, Inc.

Hypertension

Body Build and Risk of Cardiovascular Events in Hypertension and Left Ventricular Hypertrophy

The LIFE (Losartan Intervention For Endpoint reduction in hypertension) Study

Giovanni de Simone, MD; Kristian Wachtell, MD; Vittorio Palmieri, MD; Darcy A. Hille, MS; Gareth Beevers, MD; Björn Dahlöf, MD, PhD; Ulf de Faire, MD; Frej Fyhrquist, MD; Hans Ibsen, MD; Stevo Julius, MD; Sverre E. Kjeldsen, MD; Ole Lederballe-Pedersen, MD; Lars H. Lindholm, MD; Markku S. Nieminen, MD; Per Omvik, MD; Suzanne Oparil, MD; Richard B. Devereux, MD

From the Department of Clinical and Experimental Medicine, Federico II University of Naples, Naples, Italy (G.d.S., V.P.); Division of Cardiology, Weill Medical College of Cornell University, New York, NY (K.W., G.d.S., V.P., R.B.D.); Department of Medicine, Glostrup University Hospital, Glostrup, Denmark (K.W., H.I.); Merck Research Laboratories, Blue Bell, Penn (D.A.H.); Dudley Road Hospital, Birmingham, United Kingdom (G.B.); Department of Medicine, Sahlgrenska University Hospital/Östra, Göteborg, Sweden (B.D.); Karolinska University Hospital, Stockholm, Sweden (U.d.F.); Helsinki University Hospital, Helsinki, Finland (F.F., M.S.N.); University of Michigan Medical Center, Ann Arbor, Mich (S.J., S.E.K.); Ullevaal University Hospital, Oslo, Norway (S.E.K.); Viborg University Hospital, Viborg, Denmark (O.L.-P.); Umeå University Hospital, Umeå, Sweden (L.H.L.); Haukeland University Hospital, Bergen, Norway (P.O.); and University of Alabama, Birmingham, Ala (S.O.).

Correspondence to Giovanni de Simone, MD, Department of Clinical and Experimental Medicine, Federico II University Hospital, via S. Pansini, No. 5, 80131 Naples, Italy. E-mail simogi{at}unina.it

Received October 25, 2004; revision received February 11, 2005; accepted February 17, 2005.

Background— Obesity may independently increase the risk of adverse events in hypertension with target-organ damage. We investigated whether body build was independently associated with higher cardiovascular risk and whether treatment with losartan relative to atenolol influenced the impact of body build on the primary composite end point of cardiovascular death, stroke, and myocardial infarction and on cardiovascular death in patients with hypertension and left ventricular hypertrophy in the Losartan Intervention For Endpoint reduction in hypertension (LIFE) study.

Methods and Results— The population of 9079 patients was divided as follows: thin (body mass index [BMI] <20 kg/m², 2%), normal weight (BMI 20 to 24.9, 24%), overweight (BMI 25 to 29.9, 45%), and obese (class I: BMI 30 to 34.9, 21%; class II: BMI 35 to 39.9, 6%; class III: BMI 40, 2%). Incident diabetes increased progressively with BMI and was somewhat higher in the atenolol arm. Differences in gender and race were detected among the body build groups. Rates (Cox proportional hazard analysis) of the primary composite end point did not differ among body build groups after adjustment for age, gender, race, smoking habit, prevalent cardiovascular disease, and left ventricular hypertrophy. Cardiovascular death was more frequent among thin (P<0.05) and pooled class II-III obesity (both P<0.04) than normal-weight groups. Risk was not attenuated significantly by losartan treatment, nor did it interfere with the greater benefit of losartan- as opposed to atenolol-based treatment.

Conclusions— In the LIFE study, stratification for classes of body build identified increased risk of cardiovascular mortality in both thin and moderately-to-severely obese individuals. This risk was not attenuated significantly by losartan treatment, nor did it interfere with the greater benefit of losartan-based treatment as opposed to atenolol-based treatment.

Key Words: hypertension • obesity • drugs • risk factors • prognosis

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