Heart Failure Prevention Is the Best Option To Stem High Costs and Disease Burden

Abstract

In this issue of Circulation: Cardiovascular Quality and Outcomes , Okin and colleagues1 report on the incidence of heart failure in a cohort of patients with hypertension enrolled in the Losartan Intervention for End Point Reduction in Hypertension (LIFE) study. This study, an international randomized trial, demonstrated that losartan, when compared with atenolol, provided superior reduction of events in high-risk patients with hypertension and no history of heart failure before enrollment.2 Over a 5-year follow-up period, the incidence of heart failure in blacks was 7%, significantly higher than the 3.1% incidence rate found in nonblack patients. This difference persisted even when appropriately adjusted for differences such as the heavier risk factor burden, younger age, sex, renal disease, diabetes mellitus, randomized treatment, incident myocardial infarction, in-treatment QRS duration, strain and left ventricular hypertrophy as measured by ECG, and diastolic and systolic pressure. Additionally, an echocardiographic substudy demonstrated adverse differences in left ventricular structure and performance after 2 years of antihypertensive therapy in blacks compared to nonblacks. Article see p 157 These findings are consistent with several previous reports detailing heart failure differences in blacks, who, when receiving their diagnosis of heart failure, are younger; have greater risk factor burden; are more overweight; and are more likely to have diabetes, renal disease, less coronary disease, and higher heart failure-related hospitalization and death rates than whites.3,4 Unique in this report is that the cohort is entirely high-risk patients with hypertension. The small numbers of black participants (497) compared with white participants (8199), and thus, small numbers of new heart failure cases in blacks, is an important recognized limitation. The definition of heart failure relied on predefined hospital-based criteria and confirmatory evidence of heart failure as a cause of death. Blacks more often have impaired medical access, and thus …