Losartan Lowers CV Complications of Hypertension

March 26, 2002

NEW YORK (MedscapeWire) Mar 26 — A head-to-head trial reported in the March 23 issue of The Lancet shows that losartan is better than atenolol at reducing cardiovascular disease and stroke, with similar degrees of blood pressure lowering and fewer adverse effects.

"Blood-pressure reduction achieved with beta-blockers and diuretics is the best recorded intervention to date for the prevention of cardiovascular morbidity and death in patients with hypertension," write Björn Dahlöf from Östra University Hospital, Sweden, and colleagues from the Losartan Intervention for Endpoint reduction in Hypertension study (LIFE). "Left ventricular hypertrophy (LVH) is a strong independent indicator of risk of cardiovascular illness and death."

In this randomized, multicenter trial based in Europe and the United States, 9193 hypertensive patients with LVH, aged 55-80 years, received either losartan-based or atenolol-based antihypertensive treatment for at least 4 years and until 1040 patients had a primary cardiovascular event defined as death, myocardial infarction, or stroke.

Both treatments were equally effective in reducing blood pressure, with mean reduction of 30/17 mmHg for losartan and 29/17 mmHg for atenolol. Compared with atenolol, losartan prevented more cardiovascular illness, death, and new-onset diabetes. Losartan reduced the overall risk of primary cardiovascular event by 13%, cardiovascular death by 11%, and fatal or nonfatal stroke by 25%. Patients given atenolol had a 7% reduction in risk of fatal and nonfatal myocardial infarction.

"Losartan prevents more cardiovascular morbidity and death than atenolol for a similar reduction in blood pressure and is better tolerated," the authors write. "Losartan seems to confer benefits beyond reduction in blood pressure. Our results are directly applicable in clinical practice and should affect future guidelines."

In a separate study published in the same issue of The Lancet, Lars Hjalmar Lindholm from Umea University, Sweden, and other LIFE investigators compared the efficacy of losartan and atenolol in 1195 patients who had diabetes as well as hypertension and LVH. Losartan reduced the risk of cardiovascular death, stroke, and myocardial infarction by 24%, the risk of cardiovascular death by 37%, and the risk of death from all causes by 39%.

Results from both LIFE studies also were presented at the American College of Cardiology annual meeting in Atlanta, Georgia, on March 20.

"A treatment strategy based on [the combination of an angiotensin-renin blocker with low-dose hydrochlorothiazide] provides at least equal cardioprotection to beta-blockers and more protection from strokes with the further benefit of fewer side effects," Hans Brunner from CHUV, Lausanne, Switzerland, writes in a commentary accompanying The Lancetarticles. "The LIFE trial has added one more piece of evidence to support our claim that angiotensin II is an important risk factor in cardiovascular disease."

Merck supported the LIFE study through an unrestricted grant.

Lancet.2002;359(9311):995-1003

Reviewed by Gary D. Vogin, MD

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