ATLANTA, GA — March 20, 2002 — The angiotensin II receptor antagonist losartan (Cozaar; Merck) is more effective in reducing the combined end point of death, heart attack and stroke among hypertensives than the beta blocker atenolol, according to Losartan Intervention for Endpoint reduction (LIFE) trial.
"This study will have important implications for clinical practice," said Bjorn Dahlof, MD, PhD, lead author of the study and associate professor of medicine at Ostra University Hospital, in Goteborg, Sweden.
The LIFE study enrolled hypertensive individuals with evidence of left ventricular hypertrophy, randomizing 9,193 participants to either losartan or atenolol; patients were followed for an average of 4.8 years.
Dr. Dahlof said that among the 4,588 patients receiving atenolol, there were 588 primary end point events compared with 508 events among the 4,605 patients taking losartan. That translated to a 13 percent lower risk of suffering one of the events, and reached statistical significance at the p=0.021 level.
The main difference between the two groups was among those patients who had a stroke, Dr. Dahlof said. In the study, 232 patients on losartan had a stroke compared with 309 patients taking atenolol.
"We believe that the decline in stroke among the losartan patients is related to the favorable effect losartan has on left ventricular hypertrophy," he said."Left ventricular hypertrophy is a strong independent indicator of risk of cardiovascular morbidity and death. We aimed to establish whether selective blocking of angiotensin II improves left ventricular hypertrophy beyond reducing blood pressure, and, consequently, reduces cardiovascular morbidity and death."