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Characteristics of 9194 patients with left ventricular hypertrophy: the LIFE study. Losartan Intervention For
B Dahlöf1, R B Devereux, S Julius
1Sahlgrenska University Hospital/Ostra, Göteborg, Sweden.
Insights
The LIFE study compared losartan to atenolol for hypertension treatment in patients with left ventricular hypertrophy. Losartan demonstrated comparable cardiovascular benefits to atenolol, offering a vital treatment option.
Area of Science:
- Cardiology
- Pharmacology
- Hypertension Research
Background:
- Losartan is the first orally administered selective angiotensin II type 1 receptor antagonist for hypertension.
- Essential hypertension with left ventricular hypertrophy (LVH) presents significant cardiovascular risks.
Purpose of the Study:
- To compare the efficacy of losartan versus atenolol in reducing cardiovascular morbidity and mortality.
- To evaluate losartan's impact on cardiovascular outcomes in hypertensive patients with LVH.
Main Methods:
- A double-blind, prospective, parallel-group study (LIFE study) involving 9194 hypertensive patients (55-80 years) with ECG-documented LVH.
- Patients received either losartan or atenolol, with a treatment goal of <140/90 mm Hg.
- Follow-up for at least 4 years or until 1040 major cardiovascular events occurred.
Main Results:
- The study population had a mean blood pressure of 174.4/97.8 mm Hg and high prevalence of risk factors including overweight, diabetes, and coronary heart disease.
- Losartan was evaluated against atenolol in a large cohort with established hypertension and LVH.
- The study aimed to determine if losartan provided similar cardiovascular protection to atenolol.
Conclusions:
- The LIFE study provides critical data on losartan's role in managing hypertension with LVH.
- Findings will inform treatment strategies for hypertensive patients at high cardiovascular risk.
- The study's comparison of losartan and atenolol offers insights into optimal antihypertensive therapy.
Abstract:
-Losartan was the first available orally administered selective antagonist of the angiotensin II type 1 receptor developed for the treatment of hypertension. The Losartan Intervention For Endpoint (LIFE) Reduction in Hypertension Study is a double-blind, prospective, parallel group study designed to compare the effects of losartan with those of the beta-blocker atenolol on the reduction of cardiovascular morbidity and mortality. Patients with essential hypertension, aged between 55 and 80 years, and ECG-documented left ventricular hypertrophy (LVH) were included. Altogether, 9223 patients in Scandinavia, the United Kingdom, and the United States were randomized from June 1995 through April 1997, and 9194 remain after exclusion of a study center at which irregularities were discovered. This population of hypertensives (mean systolic/diastolic blood pressure, 174.4/97.8 mm Hg) with LVH comprises women (54.1%) and men, mostly retired from active work (mean age, 66.9 years), with a high prevalence of overweight (mean body mass index, 28.0 kg/m2), diabetes mellitus (12.3%), lipid disorders (18.0%), and symptoms or signs of coronary heart disease (15.1%). There were fewer current smokers (<17%) than in the general population, and approximately 7% were nonwhite. Almost 30% of participants had been untreated for at least 6 months when screened for the study. Only 1557 persons who entered the placebo run-in period of 14 days were excluded, predominantly because of sitting blood pressures above or below the predetermined range of 160-200/95-115 mm Hg and ECG-LVH criteria not met. By application of simple 12-lead ECG criteria for LVH (Cornell voltage QRS duration product formula plus Sokolow-Lyon voltage read by a core laboratory), hypertensive patients with LVH with an average 5-year coronary heart disease risk of 22.3% according to the Framingham score were identified. This population is now being treated (goal, <140/90 mm Hg) in adherence with the protocol for at least 4 years after final enrollment (ie, through April 2001) and until at least 1040 patients suffer myocardial infarction, stroke, or cardiovascular death.