Body Build and Risk of Cardiovascular Events in Hypertension and Left Ventricular Hypertrophy

Abstract

Background-Obesity may independently increase the risk of adverse events in hypertension with target-organ damage.We investigated whether body build was independently associated with higher cardiovascular risk and whether treatment with losartan relative to atenolol influenced the impact of body build on the primary composite end point of cardiovascular death, stroke, and myocardial infarction and on cardiovascular death in patients with hypertension and left ventricular hypertrophy in the Losartan Intervention For Endpoint reduction in hypertension (LIFE) study. Methods and Results-The population of 9079 patients was divided as follows: thin (body mass index [BMI] Ͻ20 kg/m 2 , 2%), normal weight (BMI 20 to 24.9, 24%), overweight (BMI 25 to 29.9, 45%), and obese (class I: BMI 30 to 34.9, 21%; class II: BMI 35 to 39.9, 6%; class III: BMI Ն40, 2%). Incident diabetes increased progressively with BMI and was somewhat higher in the atenolol arm. Differences in gender and race were detected among the body build groups. Rates (Cox proportional hazard analysis) of the primary composite end point did not differ among body build groups after adjustment for age, gender, race, smoking habit, prevalent cardiovascular disease, and left ventricular hypertrophy. Cardiovascular death was more frequent among thin (PϽ0.05) and pooled class II-III obesity (both PϽ0.04) than normal-weight groups. Risk was not attenuated significantly by losartan treatment, nor did it interfere with the greater benefit of losartan-as opposed to atenolol-based treatment. Conclusions-In the LIFE study, stratification for classes of body build identified increased risk of cardiovascular mortality in both thin and moderately-to-severely obese individuals. This risk was not attenuated significantly by losartan treatment, nor did it interfere with the greater benefit of losartan-based treatment as opposed to atenolol-based treatment.

Sympathetic nervous system in obesity-related hypertension: mechanisms and clinical implications

“…104,105 Importantly, β-blockers prevented significantly fewer events than these other classes in subgroup analyses restricted to obese subjects. 105,106 The inferiority of β-blockers may relate to several factors, including weight gain (3–4 kg on long-term use), type 2 diabetes, low high-density lipoprotein and high triglycerides. 103,107 β-Blockers also lessen exercise tolerance and cause erectile dysfunction.…”

Normal values of left-ventricular mass

“…Four, echocardiographic variables (namely left-ventricular mass) are usually normalized for anthropometric measures to adjust for inter-individual body size variations. The more appropriate method for normalizing left-ventricular mass in adults is still debated: indexation to height 2.7 has been reported to improve LVH detection in obese individuals, whereas indexation to BSA appears more suitable for normal-weight individuals [23,24]. Interestingly, in our study population prevalence of LVH was similar by both indexation methods (2.8 vs. 3.5%).…”

Body weight, weight change and the risk of cardiovascular disease in patients with hypertension: a primary-care cohort study

“…However, the effect of excessive body weight on CVD in patients with hypertension is less clear [11]. The LIFE (Losartan Intervention for Endpoint reduction in hypertension) study found that higher risks of cardiovascular death were observed in groups with obesity than in normal weight groups [12]. However, a recent study suggested a survival bene t in overweight patients with hypertension compared to subjects with normal weight [13].…”