CIPLADOC -Cardiology Update - Landmark Trials

CARDIOLOGY UPDATE - Landmark Trials

THE LIFE STUDY

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Losartan proven to be superior to atenolol
in reducing cardiovascular mobidity, mortality and stroke

Life Study results are directly applicable in clinical
practice and should affect future guidelines.

The Losartan Intervention for Endpoint Reduction
in hypertension study (LIFE) :
a randomized trial against atenolol

Background

Treated patients with hypertension still have significantly higher rates of hypertension-related
cardiovascular complications than matched people without hypertension. This might result from
failure to achieve normal blood pressure, residual target organ damage such as left ventricular
hypertrophy (LVH), or both. LVH is an independent risk factor for all cardiovascular complications
in hypertension, and reversal of LVH has possible benefits that are independent of blood pressure.

Aim

To compare the long-term effects of Losartan and Atenolol on cardiovascular morbidity and
mortality in patients with hypertension and LVH.

Patient Characteristics

9193 patients aged 55-80 years with essential hypertension and LVH (ascertained by
electrocardiography).

Study duration

Mean follow-up : 4.8 years

Study groups

Losartan vs Atenolol
If blood pressure was not adequately controlled, hydrochlorothiazide was added.


Results
		Losartan reduced the risk of cardiovascular mortality, stroke or myocardial infarction by 13% as compared to atenolol.


		Losartan reduced stroke by 24.9% as compared to atenolol


		Incidence of new-onset diabetes was 25% lower in the losartan group than in the atenolol group


		Losartan caused a significant reduction in LVH


		Target blood pressure (< 140/90 mmHg) was achieved in 48% patients in losartan group and 45% patients in atenolol group.

		Heart rate decreased more in atenolol group (-7.7 beats/minute) than losartan group (-1.8 beats/minute).

		Discontinuation rates were significantly less common in losartan than atenolol patients.


Conclusion Losartan prevents more cardiovascular morbidity and death than atenolol for a similar reduction in blood pressure and is better tolerated. Losartan seems to confer benefits beyond reduction in blood pressure
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