[The effect of losartan versus atenolol on cardiovascular morbidity and mortality in patients with diabetes mellitus in the LIFE-study].
BACKGROUND
The most suitable antihypertensive drug to reduce the risk of cardiovascular disease in patients with hypertension and diabetes is unclear. In a prespecified analysis of the LIFE-study we compared the effects of losartan and atenolol on cardiovascular morbidity and mortality in diabetic patients.


METHODS
A total of 1195 patients in the LIFE-study had diabetes at the time of the randomisation. The patients were randomised for double-blind treatment with losartan versus atenolol. The patients had ECG-verified left ventricular hypertrophy, mean age 67 years, blood pressure 177/96 mmHg after two weeks placebo run-in period. Patients were followed for at least four years (mean 4.7 years). The primary composite endpoint was cardiovascular death, stroke or myocardial infarction.


RESULTS
Blood pressure was reduced to 146/79 and 148/79 in losartan-treated patients and atenolol-treated patients, respectively. The primary endpoint occurred in 103 patients assigned losartan (n = 586) and 139 assigned atenolol (n = 609). Relative risk reduction 24% (p < 0.031). Cardiovascular mortality was reduced by 37% in favour of losartan (p < 0.028), and all cause mortality by 39% (p < 0.002).


CONCLUSIONS
Losartan was very effective in reducing cardiovascular morbidity and mortality as compared to atenolol. These results will have a major impact on the choice of anti-hypertensive treatment for patients with hypertension and diabetes.
Ibsen
Hans
H
Medicinsk Afdeling M, Amtssygehuset i Glostrup, DK-2600 Glostrup.
Lindholm
Lars H
LH
Pedersen
Ole Lederballe
OL
Dahlöf
Björn
B
Kjeldsen
Sverre
S
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001262:Atenolol / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000188:drug therapy*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D019808:Losartan / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors
D000319:Adrenergic beta-Antagonists; D000959:Antihypertensive Agents; D001262:Atenolol; D019808:Losartan