Losartan versus Atenolol for Hypertension (LIFE)

Overall Results and Diabetic Patient Subset

Overall Study Question

These investigators examined the long term (4.8 years) benefits of treating hypertension with either losartan or atenolol.

Patients

9,193 (1195) patients mean age 67, 54% women, 25% (35%) history of vascular disease. Numbers in brackets are the the subset of patients who were diabetic at entry into the trial.

Treatment

Losartan 50-100 mg PO daily or atenolol 50-100 mg PO daily. Approximately 25% required additional drugs

Duration

4.8 years.

Results

CV mortality, MI, stroke (%) All deaths MI’s (%) Stokes (%) CV Mortality (%)
T D ND T D ND T D ND T D ND T D ND
Losartan 11 18 10 8 11 8 4 7 4 5 9 5 4 6 4
Atenolol 13 23 11 9 17 8 4 8 3 7 11 6 5 10 4
Relative Risk Reduction 15 22 Stats not done NSS 35 Stats not done NSS Stats not done 29 NSS Stats not done NSS Stats not done
Absolute Risk Reduction 2 5 6 2
NNT/NNH over 4.8 years 50 20 17 50

T= total, D = diabetic, ND = nondiabetic, NSS = not statistically significant

Systolic blood pressure was lowered by 1.1 mmHg more in the losartan group compared to the atenolol group.

How does this study contribute to the drug therapy of hypertension?

This study shows that losartan decreases the chance of cardiovascular events and deaths by more (2% and 6% respectively) than atenolol in patients with hypertension. The benefit was greater in diabetic patients than in patients without diabetes. Unfortunately, thiazide diuretics, the drugs of choice for hypertension were not used as a comparison in this trial.

Original Citation

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

Lindholm LH, Ibsen H, Dahlof B, Devereux RB, Beevers G, de Faire U, Fyhrquist F, Julius S, Kjeldsen SE, Kristiansson K, Lederballe-Pedersen O, Nieminen MS, Omvik P, Oparil S, Wedel H, Aurup P, Edelman J, Snapinn S; The LIFE Study Group.Cardiovascular morbidity and mortality in patients with diabetes in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomized trial against atenolol. Lancet 2002;359:1004-10

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