Abstract 4421: Concomitant Hydrochlorothiazide Therapy in Hypertensive Patients is Associated with Reduced Cardiovascular Morbidity and Mortality Independent of Blood Pressure and Electrocardiographic Left Ventricular Hypertrophy: The LIFE Study
We have previously shown that addition of hydrochlorothiazide (HCTZ) therapy in >70% of LIFE study patients was associated with greater regression of ECG left ventricular hypertrophy (LVH), independent of blood pressure (BP) reduction and of the greater impact of losartan therapy on regression of LVH. Whether HCTZ therapy is associated with improved outcomes independent of BP reduction and regression of ECG left ventricular hypertrophy (LVH) has not been examined. Outcomes were assessed in 9,193 hypertensive patients treated in a blinded fashion with losartan or atenolol and additional open-label HCTZ as needed according to study protocol. Patients on HCTZ at year 1 were younger, more likely to be black, were less likely to have a history of heart failure, myocardial infarction or ischemic heart disease, had higher baseline systolic and diastolic BP and more severe baseline LVH by Cornell product criteria. During 4.8±0.9 years of follow-up, use of HCTZ, treated as a time-varying covariate was associated with 34 to 67% reductions in risk of cardiovascular mortality, myocardial infarction, stroke, the LIFE composite endpoint of these three events and death from any cause after adjusting for randomized treatment assignment (Table⇓). In Cox multivariable analyses adjusting for the known predictive value of in-treatment ECG LVH by Cornell product and Sokolow-Lyon voltage, in-treatment systolic and diastolic pressure, randomized treatment effect, age, sex, race and and other baseline risk factors, HCTZ use remained associated with between 18 and 45% reductions in risk (table⇓). Concomitant HCTZ therapy is associated with lower likelihoods of CV morbidity and mortality and all-cause mortality, independent of blood pressure lowering, ECG LVH regression and randomized treatment modality.