Effects of losartan or atenolol in hypertensive patients without clinically evident vascular disease: a substudy of the LIFE randomized trial
Background: Cardiovascular morbidity and mortality are reduced by treatment with the angiotensin II AT(sub 1)-receptor antagonist losartan compared with conventional treatment with the beta-blocker atenolol in patients with hypertension and electrocardiogram-defined left ventricular hypertrophy, many of whom had known vascular disease. Objective: To determine whether losartan reduces cardiovascular event rates in lower-risk hypertensive patients without clinically evident vascular disease. Design: Subgroup analysis or a randomized trial. Setting: The Losartan Intervention For Endpoint reduction in hypertension (LIFE) study. Patients: 6886 men and women (57% women) 55 to 80 years of age (average, 66 years) with essential hypertension (sitting blood pressure, 160 to 200/95 to 115 mm Hg [average, 174/98 mm Hg]) and electrocardiogram-defined left ventricular hypertrophy who did not have clinically evident vascular disease. Intervention: Patients were randomly assigned to once-daily double-blind treatment with losartan or atenolol. Measurements: An end point committee ascertained end points (cardiovascular death, stroke, or myocardial infarction). Results: Blood pressure was reduced similarly by losartan and atenolol. The primary composite end point occurred in 282 losartan-treated patients (17.5 per 1000 patient-years) and 355 atenolol-treated patients (21.8 per 1000 patient-years; relative risk, 0.81 [95% CI, 0.69 to 0.95]; P=0.008). Cardiovascular death occurred in 103 losartan-treated patients and 132 atenolol-treated patients (relative risk, 0.80 [CI, 0.62 to 1.04]; P=0.092), stroke (nonfatal and fatal) occurred in 125 losartan-treated patients and 193 atenolol-treated patients (relative risk, 0.66 [CI, 0.53 to 0.82]; P<0.001), and myocardial infarction (nonfatal and fatal) occurred in 110 losartan-treated patients and 100 atenolol-treated patients (relative risk, 1.14 [CI, 0.87 to 1.49]; P>0.2). New onset diabetes occurred less often in patients treated with losartan (n=173) than in patients treated with atenolol (n=254) (relative risk, 0.69 [CI, 0.57 to 0.84]; P<0.001). Benefits of losartan treatment were numerically smaller, but not significantly so, in patients with pre-existing vascular disease. Conclusion: In hypertensive patients without clinically evident vascular disease, losartan was more effective than atenolol in preventing cardiovascular morbidity and death, predominantly stroke, independent of blood pressure reduction.
Publication Name: Annals of Internal Medicine
Prognostic significance of left ventricular mass change treatment of hypertension
Reduction of left ventricular (LV) mass during antihypertensive treatment whether modifies risk of major cardiovascular (CV) events independent of blood pressure change is determined. Increases baseline LV mass predicts CV complications of hypertension, but the relation between lower LV mass and outcome during treatment for hypertension is uncertain.
Publication Name: JAMA, The Journal of the American Medical Association
Benefits of losartan in patients with hypertension and left ventricular hypertrophy but no vascular disease
The drug losartan may be effective than atenolol in lowering blood pressure in patients with hypertension who have an enlarged heart but no other evidence of cardiovascular disease, according to a study of 6,886 patients. Losartan belongs to a group of drugs called angiotensin II receptor blockers and atenolol is a beta blocker.
Publication Name: Annals of Internal Medicine
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