Abstract 3624: Impact of Overweight and Obesity on Changes in Left Ventricular Structure and Function During Losartan- or Atenolol-based Antihypertensive Treatment (the LIFE study)
Background: Increased body mass index (BMI) is associated with left ventricular hypertrophy (LVH) and higher cardiovascular (CV) mortality.
Methods: To investigate the influence of obesity on treatment-induced changes in LV structure and function and CV mortality, annual BMI and echocardiograms and CV mortality (a secondary study endpoint) were recorded in 862 hypertensive patients with electrocardiographic LVH during 4.8 years randomized losartan- or atenolol-based treatment in the Losartan Intervention For Endpoint reduction in hypertension (LIFE) echocardiography substudy. Patients were grouped by baseline BMI (Table 1⇓).
Results: Blood pressure and LV mass/height2.7 were reduced in all groups (all p<0.01). The obese groups were younger, included more women and had higher prevalence of LVH both at baseline and final study echocardiogram (all p<0.01) (Table 1⇓). In linear regression analysis, adjusting for initial LV mass/height2.7, higher BMI was associated with less LVH reduction, independent of significant effects of age, systolic blood pressure (SBP) reduction, improvement in LV ejection fraction (EF), previous myocardial infarction and losartan-based treatment (multiple R2 = 0.35, p<0.001). In a similar model, higher BMI was independently associated with more reduction in LVEF (multiple R2 = 0.29, p<0.001). During follow-up, a total of 22 CV deaths occurred. In Cox regression analysis including time-varying SBP, LV mass and LVEF, and baseline Framingham risk score and study treatment allocation as fixed covariates, time-varying BMI predicted higher CV mortality (HR 1.10 per kg/m2 [95% CI 1.00–1.22], p<0.05) independent of significant contributions of time-varying LV mass and Framingham risk score.
Conclusions: In hypertensive patients in the LIFE study, increased BMI was associated with less reduction of LVH, more reduction in LVEF and increased CV mortality independent of LV changes during losartan- or atenolol-based treatment.