LIFE (losartan)
Trial question
Is losartan-based regimen superior to atenolol-based regimen in patients with essential hypertension and LVH?
Study design
Multi-center
Double blinded
RCT
Population
Characteristics of study participants
54.0% female
46.0% male
N = 9193
9193 patients (4963 female, 4230 male).
Inclusion criteria: patients aged 55-80 years with essential hypertension and LVH ascertained by electrocardiography.
Key exclusion criteria: secondary hypertension, MI or stroke within the previous 6 months, HF or LVEF ≤ 40%.
Interventions
N=4605 a losartan-based regimen (titrated doses of losartan at 50-100 mg with/without hydrochlorothiazide 12.5-25 mg or other antihypertensive treatment for at least 4 years).
N=4588 an atenolol-based regimen (titrated doses of atenolol at 50-100 mg with/without hydrochlorothiazide 12.5-25 mg or other antihypertensive treatment for at least 4 years).
Primary outcome
Death, MI, or stroke
11%
13%
13.0 %
9.8 %
6.5 %
3.3 %
0.0 %
A losartan-based
regimen
An atenolol-based
regimen
Significant
decrease ▼
NNT = 50
Significant decrease in death, MI, or stroke (11% vs. 13%; aHR 0.87, 95% CI 0.77 to 0.98).
Secondary outcomes
No significant difference in CV death (4% vs. 5%; aHR 0.89, 95% CI 0.73 to 1.07).
Significant decrease in stroke (5% vs. 7%; aHR 0.75, 95% CI 0.63 to 0.89).
Significant decrease in new-onset diabetes (6% vs. 8%; aHR 0.75, 95% CI 0.63 to 0.88).
Safety outcomes
No significant differences in angioedema, cancer, cough, dizziness, sleep disturbance.
Significant differences in bradycardia (1% vs. 9%), cold extremities (4% vs. 6%), hypotension (3% vs. 2%), sexual disturbance (4% vs. 5%).
Conclusion
In patients aged 55-80 years with essential hypertension and LVH ascertained by electrocardiography, a losartan-based regimen were superior to an atenolol-based regimen with respect to death, MI, or stroke.
Reference
Björn Dahlöf, Richard B Devereux, Sverre E Kjeldsen et al. 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.
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