Losartan versus atenolol for diabetic hypertensive patients with LVH

Losartan appears to be more effective than atenolol in reducing cardiovascular morbidity and mortality as well as mortality from all causes in patients with hypertension, diabetes, and LVH.

In a double-masked, randomized, parallel-group trial (LIFE) 1 195 diabetic patients (of the total of 9 193) aged 55 - 88 years with electrocardiographically ascertained LVH received either losartan ad 100 mg/d or atenolol 100 mg/d. Most patients also received hydrochlorothiazide. The primary composite end point (death, myocardial infarction, or stroke) occurred in 103 losartan and in 139 atenolol patients (RR 0.76, 95% CI 0.58 to 0.98). 38 and 61 patients in the losartan and atenolol groups, respectively, died from cardiovascular disease (RR 0.63, 95% CI 0.42 to 0.95). Mortality from all causes was 63 and 104 in losartan and atenolol groups (RR 0.61, 95% CI 0.45 to 0.84).

Comment: The quality of evidence is downgraded by imprecise results (few outcome events).

The following decision support rules contain links to this evidence summary:

• Replacing atenolol with other antihypertensives

Ədəbiyyat

1. Dahlöf B, Devereux RB, Kjeldsen SE, Julius S, Beevers G, de Faire U, Fyhrquist F, Ibsen H, Kristiansson K, Lederballe-Pedersen O, Lindholm LH, Nieminen MS, Omvik P, Oparil S, Wedel H, LIFE Study Group. Cardiovascular morbidity and mortality in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol. Lancet 2002 Mar 23;359(9311):995-1003.