title: Losartan versus atenolol-based antihypertensive treatment reduces cardiovascular events especially well in elderly patients:  the Losartan Intervention For Endpoint reduction in hypertension (LIFE) study.
abstract: BACKGROUND
  The Losartan Intervention For Endpoint reduction in hypertension (LIFE) study has previously demonstrated a beneficial effect of losartan compared to atenolol-based antihypertensive treatment in patients with essential hypertension and left-ventricular hypertrophy (LVH). However, patient age often influences the choice of antihypertensive drugs. Therefore, we investigated the influence of age on the effects of losartan versus atenolol-based antihypertensive treatment.
  
  
  METHODS
  A total of 9193 hypertensive patients with LVH aged 45-83 years were followed for a mean of 4.8 years. Blood pressure, high-density lipoprotein cholesterol (HDL-C), Sokolow-Lyon voltage, Cornell voltage-duration product and urine albumin-creatinine ratio (UACR) were measured yearly throughout the study. Patients were divided into two age groups according to the median age of 67 years and the effects of losartan versus atenolol-based antihypertensive treatment on the primary composite endpoint (CEP) consisting of cardiovascular death, nonfatal stroke or nonfatal myocardial infarction were investigated.
  
  
  RESULTS
  The beneficial effect of losartan versus atenolol-based treatment was greater in the group of patients older than 67 years [hazard ratio 0.79 (0.69-0.91), P = 0.001] compared to the group of patients younger than 67 years [hazard ratio 1.03 (0.82-1.28), P = 0809], P = 0.045 for interaction. The beneficial effects of losartan versus atenolol-based antihypertensive treatment on pulse pressure, HDL-C, UACR, and Cornell and Sokolow-Lyon voltage were not more pronounced in patients older than 67 years compared to patients younger than 67 years. All five risk factors considered as time-varying covariates predicted CEP independently (P < 0.01) with the exception of pulse pressure (P = 0.37) and the interaction between age and treatment on outcome remained significant (P = 0.042).
  
  
  CONCLUSIONS
  We showed a greater beneficial effect of losartan versus atenolol-based antihypertensive treatment in the group of patients older than 67 years compared to the group of patients younger than 67 years. This difference was not explained by a more pronounced effect of losartan-based treatment on any of the cardiovascular risk factors demonstrated to have independent prognostic importance.
authors.affiliation: Department of Internal Medicine, Glostrup Hospital, Glostrup, Denmark. annechristinehuth@hotmail.com
authors.forename: Anne Christine H
authors.initials: AC
authors.lastname: Ruwald
authors.forename: Bo
authors.initials: B
authors.lastname: Westergaard
authors.forename: Thomas
authors.initials: T
authors.lastname: Sehestedt
authors.forename: Sverre E
authors.initials: SE
authors.lastname: Kjeldsen
authors.forename: Lars H
authors.initials: LH
authors.lastname: Lindholm
authors.forename: Kristian
authors.initials: K
authors.lastname: Wachtell
authors.forename: Richard B
authors.initials: RB
authors.lastname: Devereux
authors.forename: Hans
authors.initials: H
authors.lastname: Ibsen
authors.forename: Markku S
authors.initials: MS
authors.lastname: Nieminen
authors.forename: Björn
authors.initials: B
authors.lastname: Dahlöf
authors.forename: Michael H
authors.initials: MH
authors.lastname: Olsen
mesh_terms: D058671:Adrenergic beta-1 Receptor Antagonists / Q000627:therapeutic use*; D000368:Aged; D000369:Aged, 80 and over; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001262:Atenolol / Q000627:therapeutic use*; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D019808:Losartan / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors
chemical_list: D058671:Adrenergic beta-1 Receptor Antagonists; D047228:Angiotensin II Type 1 Receptor Blockers; D000959:Antihypertensive Agents; D001262:Atenolol; D019808:Losartan