[The effect of losartan versus atenolol on cardiovascular morbidity and mortality in patients with hypertension and ECG-verified left ventricular hypertrophy in the LIFE-study].
BACKGROUND
Left ventricular hypertrophy is a strong independent predictor of risk of cardiovascular morbidity and death. The aim of the LIFE-study was to establish whether treatment with the angiotensin-II AT 1-receptor antagonist, losartan, reduced cardiovascular events more effectively than treatment with the betablocker atenolol in patients with hypertension and left ventricular hypertrophy.


METHODS
The LIFE-study included 9193 patients with essential hypertension and ECG-verified left ventricular hypertrophy, age range 55-80 years, systolic blood pressure in sitting position 160-200 mmHg and/or diastolic blood pressure 95-115 mmHg. Patients were randomized to double-blind treatment with losartan versus atenolol. They were followed for at least four years and until 1040 patients had a primary cardiovascular event (cardiovascular death, myocardial infarction or stroke).


RESULTS
Blood pressure fell by 30.2/16.6 and 29.1/16.8 mmHg in the losartan and the atenolol group, respectively. The primary composite endpoint occurred in 508 losartan and 588 atenolol patients (relative risk 0.87, p = 0.021). A total of 232 and 309, respectively, had fatal or non-fatal stroke (relative risk 0.75, p = 0.001). There was no difference in myocardial infarction. New-onset diabetes was 25% less frequent on losartan. Side effects were less on losartan compared to atenolol.


CONCLUSIONS
Losartan prevents to a higher degree cardiovascular morbidity and death than atenolol for a similar reduction in blood pressure and is better tolerated.
Ibsen
Hans
H
Medicinsk Afdeling M, Amtssygehuset i Glostrup.
Pedersen
Ole Lederballe
OL
Dahlöf
Björn
B
Kjeldsen
Sverre E
SE
Lindholm
Lars H
LH
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*; D004311:Double-Blind Method; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D017379:Hypertrophy, Left Ventricular / Q000150:complications / Q000175:diagnosis / 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