The Losartan Intervention for Endpoint Reduction (LIFE) Trial - Have Angiotensin-Receptor Blockers Come of Age?

Domenic A. Sica, MD, Michael Weber, MD

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Abstract and Introduction

The Losartan Intervention for Endpoint Reduction trial is one of several end-point trials that are now available with angiotensin-receptor blockers. This trial compared two regimens -- losartan-based therapy to atenolol-based therapy -- in 9193 hypertensive patients with electrocardiographic evidence of left ventricular hypertrophy. In the instance of each of these therapeutic groups, hydrochlorothiazide add-on therapy was permitted as per protocol. Although blood pressures were comparably reduced in both the losartan and the atenolol-based treatment groups, stroke rate was notably less in the losartan-treatment group. The 1195 patient diabetic cohort in this trial also experienced a substantial reduction in total and cardiovascular mortality favoring losartan. An additional finding in this trial was that new-onset diabetes developed 25% less frequently in the losartan-treated group. The results of this trial are both interesting and relevant to what is an expanding use of angiotensin-receptor blockers in the hypertensive population.

Seven angiotensin-receptor blockers (ARBs) are currently available in the United States. Each of these several drugs reduces blood pressure (BP) comparably to what has been observed with other drug classes such as angiotensin-converting enzyme (ACE) inhibitors, calcium channel blockers, and blockers. To date, the major advantage of these drugs has resided in the virtual absence of side effects when they are used. It has long been recognized, though, that a favorable side-effect profile can serve as the marketing mantra of a drug class for only a limited period of time. Ultimately, hard end point trials are needed to prove/disprove the merit of a drug class. The findings from one such trial, the Losartan Intervention for Endpoint Reduction in Hypertension (LIFE) study, were recently published and offer important insights into the workings of this drug class.[1,2]

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