Abstract 1449: Racial Differences in Incident Heart Failure Among Hypertensive Patients During Antihypertensive Therapy: The LIFE Study
Background: Blacks have a higher prevalence of heart failure (HF) than non-blacks, possibly reflecting a greater burden of HF risk factors, including hypertension. Although recent data have shown that incident HF is significantly higher in blacks during 20 year follow-up of young adults and in elderly population cohorts, the relationship of incident HF to race among hypertensive patients undergoing aggressive blood pressure lowering has not been examined.
Methods and Results: Incident HF was examined in 497 black and 8199 non-black hypertensive patients with no history of HF who were randomly assigned to losartan- or atenolol-based treatment. Compared with non-blacks, blacks were younger, more obese, more likely to smoke and have diabetes, have a history of ischemic heart disease and stroke, had higher baseline serum creatinine and albuminuria and a higher baseline prevalence of the ECG strain pattern. During 4.7±1.1 years mean follow-up, HF hospitalization occurred in 265 patients (3.0%); 5-year HF incidence was significantly greater in black than non-black patients (7.0 vs 3.1%, p<0.001). In univariate Cox analyses, black race was associated with a 132% increased risk of new HF (HR 2.32, 95% CI 1.58 –3.42). In Cox multivariate analyses adjusting for randomized treatment, incident MI, in-treatment heart rate, diastolic and systolic pressure, Cornell product and Sokolow-Lyon voltage criteria for left ventricular hypertrophy (LVH), age, sex, body mass index, prevalent and history of atrial fibrillation and diabetes, history of MI, ischemic heart disease, stroke, peripheral vascular disease, smoking status, baseline serum total and HDL cholesterol, creatinine, glucose, urine albumin/creatinine ratio and for the presence of the strain pattern on the baseline ECG, black race remained associated with an 85% increased risk of developing new HF (HR 1.85, 95% CI 1.01–3.38).
Conclusions: Incident HF is substantially more common among black than white hypertensive patients. The increased risk of developing new HF in black patients persists after adjusting for the higher prevalence of HF risk factors in blacks, for treatment effects and in-treatment blood pressure and for the known predictive value of in-treatment ECG LVH for incident HF in this population.