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[Treatment of hypertension in patients with left ventricular hypertrophy]
Per Omvik1, Bjørn Bratland, Gerhard Gerhardsen
1LIFE-studiegruppen. per.omvik@med.uib.no
Insights
The LIFE study found that losartan significantly reduced cardiovascular events compared to atenolol, even with similar blood pressure reduction. Losartan also showed benefits in specific patient groups, including those with isolated systolic hypertension and diabetes.
Area of Science:
- Cardiology
- Hypertension Management
- Pharmacology
Background:
- The LIFE study was a randomized, double-blind trial comparing losartan and atenolol for hypertension treatment.
- The study aimed to determine if losartan offered superior cardiovascular protection compared to atenolol.
Purpose of the Study:
- To compare the efficacy of losartan versus atenolol in reducing cardiovascular morbidity and mortality.
- To assess the additional benefits of losartan beyond blood pressure control.
Main Methods:
- A large-scale, randomized, double-blind trial involving 9193 patients across seven countries.
- Comparison of losartan-based versus atenolol-based antihypertensive treatment regimens.
Main Results:
- Both treatments achieved similar blood pressure reduction (30/17 mmHg vs. 29/17 mmHg).
- Losartan significantly reduced the primary combined endpoint (cardiovascular mortality, stroke, myocardial infarction) by 13.0% (p=0.021).
- Significant reductions were observed for strokes (24.9%, p=0.001), cardiovascular mortality in isolated systolic hypertension (46%, p=0.01), and total mortality in diabetes (39%, p=0.002).
Conclusions:
- Losartan demonstrated superior cardiovascular protection compared to atenolol, independent of blood pressure control.
- Losartan offers additional benefits in patients with hypertension and left ventricular hypertrophy.
Background:
The LIFE study (Losartan Intervention For Endpoint reduction in hypertension) is a randomized, double-blind comparison of losartan and atenolol-based treatment. The study hypothesis was that losartan would reduce cardiovascular morbidity and mortality more than traditional antihypertensive treatment with atenolol.
Material And Methods:
The study included 9193 patients in seven countries.
Results:
By the end of the study, the mean dose was losartan 82 mg and atenonol 79 mg, whereas 94% of patients in both groups received additional hydrochlorothiazide. Blood pressure was reduced 30/17 mmHg by losartan and 29/17 mm Hg by atenolol. Despite the same reduction in blood pressure, the primary combined endpoint (cardiovascular mortality, non-fatal stroke and myocardial infarction) was reduced by 13.0% (p = 0.021) in the losartan group. Non-fatal and fatal strokes were reduced by 24.9% (p = 0.001). In two pre-specified subgroup analyses, cardiovascular mortality was reduced by 46% (p = 0.01) in patients with isolated systolic hypertension (n = 1326), and total mortality was reduced by 39% (p = 0.002) in patients with diabetes (n = 1159).
Interpretation:
Losartan prevented more cardiovascular complications than atenolol for the same reduction in blood pressure and have positive additional effects beyond blood pressure control in patients with hypertension and left ventricular hypertrophy.
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