The effect of losartan compared with atenolol on the incidence of revascularization in patients with hypertension and electrocardiographic left ventricular hypertrophy. The LIFE study

Abstract

The effect of losartan compared with atenolol on the incidence of revascularization in patients with hypertension and electrocardiographic left ventricular hypertrophy. The LIFE study In the Losartan Intervention For End point reduction in hypertension (LIFE) study losartan-compared to atenolol-based antihypertensive treatment showed a tendency towards reducing peripheral revascularization (4.4 vs 57, P ¼ 0.07). This benefit was significant in the patients without peripheral vascular disease or without albuminuria at baseline (both Po0.01), suggesting that losartan may be particularly effective in preventing vascular damage in patients without preexisting vascular damage.In the LIFE study, the rate of myocardial infarction did not significantly differ between the treatment groups when losartan-compared with atenololbased treatment was administered to patients with hypertension and left ventricular hypertrophy (LVH) for a mean of 4.8 years. 1 On the other hand, in a subgroup of patients in the LIFE study, losartanbased, but not atenolol-based antihypertensive treatment, reduced carotid artery hypertrophy. 2 Furthermore, angiotensin II has experimentally been associated with development of atherosclerosis, 3 and blockage of the renin-angiotensin-aldosterone system may reduce atherosclerosis. 4 In the present analysis, we aimed to identify risk predictors for coronary and peripheral revascularizations in this large study and to investigate the effect of losartanbased compared with atenolol-based antihypertensive treatment on the incidences of coronary and peripheral revascularizations.The LIFE study design has been previously published. 5 9193 hypertensive patients aged 55-80 years with electrocardiographic (ECG) LVH were randomized to losartan-or atenolol-based antihypertensive treatment for a mean of 4.8 years. The revascularization analyses were pre-specified as part of the LIFE protocol. 5 Coronary revascularization included all coronary artery revascularization procedures (angioplasty, atherectomy and stent) and heart transplant. Peripheral revascularization included all noncoronary artery vascular surgeries and revascularization procedures (aortic aneurysm repair, carotid and peripheral revascularizations and amputations that were the result of arterial vascular insufficiency and diabetes mellitus). Revascularizations were reported by the investigators on endpoint report forms and verified by an independent endpoint classification committee consisting of two cardiology experts. All patients provided written informed consent, and the protocol was approved by all relevant ethical review committees.Data management and analysis were performed using SPSS 10.1 (SPSS, Chicago, IL, USA) software. Data are presented as mean7s.d. for continuous variables with normal distribution, median and inter-quartile range for continuous variables without normal distribution, and proportions for categorical variables. Only urinary albumin/creatinine ratio (UACR) was distributed non-normally and was transformed using logarithm of 1...

Managing hypertension in cardiology practice according to risk profile

“…Of particular note, the antihypertensive strategy most frequently adopted was losartan 100 mg plus hydrochlorothiazide (HCTZ) 12.5 mg and approximately 56% of patients received at least one dose of the combination of losartan 100 mg plus HCTZ 12.5 mg at some time during the study (61). A number of subanalyses of LIFE have also shown that, compared with an atenolol-based regimen, an antihypertensive therapy based on losartan has favourable effects in terms of organ damage protection and CV risk factor correction, as manifested by differential beneficial changes in MAU, LVH, left atrial diameter, AF, brain natriuretic peptide, vascular structure, serum uric acid, new-onset diabetes and lipid metabolism (62)(63)(64)(65)(66)(67)(68)(69)(70)(71)(72). Similarly, in patients with diabetes and renal insufficiency, ARBs resulted in greater benefits in improving MAU and slowing progression to end-stage renal disease (ESRD) than comparator drugs (73)(74)(75)(76)(77).…”