Racial Differences in Sudden Cardiac Death Among Hypertensive Patients During Antihypertensive Therapy: The LIFE Study

Study Questions:

Among patients with hypertension, are blacks at a higher risk of sudden cardiac death (SCD) than nonblacks?

Methods:

This was a post-hoc analysis of the LIFE study, in which 9,193 hypertensive patients were randomly assigned to treatment with losartan, atenolol, or placebo. There were 8,660 nonblack patients (mean age 67 years) and 533 black patients (mean age 65 years). SCDs during a mean follow-up of 4.8 years were compared between the two ethnic groups.

Results:

The 5-year SCD rate was significantly higher in black (3.9%) than in nonblack patients (1.9%). After adjusting for multiple confounding variables, black ethnicity was independently associated with a 98% higher risk of SCD.

Conclusions:

The authors concluded that black ethnicity is an independent risk factor for SCD among patients with hypertension.

Perspective:

Several studies have indicated that the risk of SCD is higher in blacks than nonblacks and this has been attributed to a higher prevalence of comorbidities such as hypertension and diabetes, and to lesser responsiveness to antihypertensive therapies. This study is important because it demonstrates that the higher risk of SCD in blacks is independent of these and many other potential confounding variables. This suggests the possibility of race-related genetic factors such as mutations or single nucleotide polymorphisms that predispose to SCD. Consistent with this possibility, there is evidence that blacks have an increased prevalence of sodium channel gene mutations.

Clinical Topics: Arrhythmias and Clinical EP, Prevention, SCD/Ventricular Arrhythmias, Hypertension

Keywords: Mutation, Ethnic Groups, Follow-Up Studies, Polymorphism, Single Nucleotide, Risk Factors, Heart Rate, African Continental Ancestry Group, Hypertension, Death, Sudden, Cardiac


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