Blood-pressure reduction achieved with ß -blockers and diuretics is the best form of treatment for the prevention of cardiovascular illness and death in patients with high blood pressure (hypertension). However, treated patients with hypertension still have significantly higher rates of hypertension-related cardiovascular complications than people with normal blood pressure. Furthermore, the condition of left ventricular hypertrophy (LVH [enlargement of the left ventricle]) is a strong independent risk factor for cardiovascular illness and death. Björn Dahlöf from Östra University Hospital, Sweden, and colleagues from the Losartan Intervention For Endpoint reduction in hypertension study (LIFE) investigated whether losartan or the ß -blocker atenolol might be better at reducing the risk of cardiovascular illness or death by improving LVH after blood-pressure reduction had been achieved.
Around 9200 hypertensive patients with LVH aged 55-80 years from Europe and the USA were randomly assigned either losartan-based or atenolol-based antihypertensive treatment for at least 4 years and until 1040 patients had a primary cardiovascular event (death, heart attack, or stroke).
Losartan prevented more cardiovascular illness and death than atenolol, although the reduction in blood pressure was similar for both treatments (30/17 and 29/17 mm Hg for losartan and atenolol, respectively). Losartan reduced the overall risk of composite endpoint by 13%, cardiovascular death by 11%, and fatal or non-fatal stroke by 25%. The risk of fatal and non-fatal heart attack was marginally reduced (by 7%) in patients given atenolol.
In a second study also published in this week’s issue of THE LANCET, Lars Hjalmar Lindholm from Umea University, Sweden, and the LIFE investigators compared the efficacy of losartan and atenolol in around 1200 patients who had diabetes in addition to hypertension and LVH. Losartan reduced the risk of cardiovascular death, stroke, and heart attack by around 25%, the risk of cardiovascular death by 37%,and reduced the risk of death from all causes by nearly 40%.
In an accompanying Commentary (p 990), Hans Brunner from CHUV, Lausanne, Switzerland, concludes: “To normalise blood pressure, more than one drug is generally needed. The LIFE trial design can therefore be considered close to the way antihypertensive therapy is provided. The combination of an ARB [angiotensin-renin blocker] with low-dose hydrochlorothiazide does not produce more side-effects than placebo. Thus a treatment strategy based on this combination provides at least equal cardioprotection to ß -blockers and more protection from strokes with the further benefit of fewer side-effects…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.”
· Results of the LIFE study will be presented at the American College of Cardiology meeting in Atlanta, GA, USA, at 12 noon on Wednesday 20 March, E.S.T. For further information please contact Janet Skidmore on +1 732 221 0390.
Contact: Dr Björn Dahlöf, Clinical Trials Unit,Department of Medicine,Östra University Hospital,S-416 85 Göteborg,Sweden;T) + 46 31 343 53 05;F) + 46 31 84 22 17;E) bdahlof@scandinaviancri.se
Professor Lars Hjalmar Lindholm, Department of Public Health and Clinical Medicine,Umea University,SE 901 85 Umea,Sweden;T) +46 90 785 35 26;F) +46 90 77 68 83;E) LarsH.Lindholm@fammed.umu.se
Dr Hans R Brunner, Division of Hypertension and Vascular Medicine, CHUV, 1011 Lausanne, Switzerland; T) +41 21 314 0750; F) +41 21 314 0761; E) Hans-R.Brunner@chuv.hospvd.ch
Journal
The Lancet