Prognostic importance of hemoglobin in hypertensive patients with electrocardiographic left ventricular hypertrophy: the Losartan Intervention For End point reduction in hypertension (LIFE) study.

Abstract

BACKGROUND:

The prognostic importance of hemoglobin is controversial. We investigated the prognostic importance of baseline and in-treatment hemoglobin in the LIFE study.

METHODS:

Eight thousand one hundred ninety-four LIFE patients with hypertension and left ventricular hypertrophy with available baseline hemoglobin measurements were randomized to losartan- or atenolol-based treatment and followed for 4.8 years for end points of all-cause mortality and composite of cardiovascular death, nonfatal stroke, or nonfatal myocardial infarction.

RESULTS:

U-shaped relations were observed between deciles of baseline hemoglobin and all-cause mortality and the composite end point. In univariate Cox models, baseline hemoglobin in the lowest gender-specific decile (women/men: <12.5/13.4 g/dL) was associated with all-cause mortality (hazard ratio [HR] 2.01, 95% CI 1.64-2.64) and the composite end point (HR 1.53, 95% CI 1.27-1.85, both P < .001), whereas hemoglobin in the highest gender-specific decile (women/men: > or =15.0/16.2 g/dL) was not. The decrease in hemoglobin was higher (P < .001) in patients allocated to losartan- (14.3-13.8 g/dL) versus atenolol-based treatment (14.3-14.0 g/dL). In Cox models with the same gender-specific definitions for high and low hemoglobin as time-varying covariates with adjustment for treatment allocation and established risk factors and diseases, hemoglobin in the lowest decile was associated with higher rates of all-cause mortality (HR 3.03, 95% CI 1.89-4.85, P < .001) and the composite end point (HR 1.36, 95% CI 1.08-1.71, P < .01), whereas hemoglobin in the highest decile was not.

CONCLUSIONS:

After adjusting for other risk factors, relatively low, but not high, hemoglobin during antihypertensive treatment was associated with higher incidence of all-cause mortality and the composite end point.

• Authors: Michael Hecht Olsen, Kristian Wachtell, Gareth Beevers, Björn Dahlöf, Richard B Devereux, Ulf de Faire, Frej Fyhrquist, Hans Ibsen, Sverre E Kjeldsen, Ole Lederballe-Pedersen, Lars H Lindholm, Puneet Narayan, Markku S Nieminen, Per Omvik, Suzanne Oparil, Hans Wedel
• Journal: American heart journal (Am Heart J) Vol. 157 Issue 1 Pg. 177-84 (Jan 2009) ISSN: 1097-6744 [Electronic] United States
• PMID: 19081416 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Adrenergic beta-Antagonists
• Antihypertensive Agents
• Hemoglobins
• Atenolol
• Losartan

Topics

• Adrenergic beta-Antagonists (therapeutic use)
• Aged
• Aged, 80 and over
• Antihypertensive Agents (therapeutic use)
• Atenolol (therapeutic use)
• Electrocardiography
• Female
• Hemoglobins (analysis)
• Humans
• Hypertension (blood, complications, drug therapy, mortality)
• Hypertrophy, Left Ventricular (complications, diagnosis)
• Losartan (therapeutic use)
• Male
• Middle Aged
• Prognosis