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Losartan vs. Atenolol for Hypertension

Hypertensive patients who took losartan were at lower risk for stroke than were those who took atenolol, despite similar BP reductions with the 2 drugs.

Clinicians continue to debate whether newer drugs should replace diuretics and ß-blockers as first-line antihypertensive agents. In this international, randomized, double-blind trial, researchers compared the angiotensin-receptor-blocker losartan with the ß-blocker atenolol in 9193 patients (age range, 55 to 80) with essential hypertension (160 to 200 mm Hg systolic, or 95 to 115 mm Hg diastolic); all patients had left ventricular hypertrophy, as determined by electrocardiography. When necessary, hydrochlorothiazide was given to patients in both groups to help achieve target blood pressures of 140/90 mm Hg. The study was sponsored by the maker of losartan.

During an average follow-up of almost 5 years, mean BP fell from about 174/98 mm Hg to about 145/81 mm Hg in both groups. However, incidence of the primary endpoint -- a composite of cardiovascular death, myocardial infarction, and stroke -- was significantly lower in the losartan group than in the atenolol group (11% vs. 13%). A lower rate of stroke, but not of MI, accounted for the difference. Losartan recipients were less likely than atenolol recipients to discontinue treatment because of adverse events (about 13% vs. about 18%). In a separate paper, the authors reported on a subset of 1195 patients with diabetes. Again, incidence of the primary endpoint was significantly lower with losartan than with atenolol (18% vs. 23%).

Comment: Results from this trial surely will be invoked to support the use of angiotensin-receptor-blockers as first-line antihypertensive drugs. The reduction in the composite endpoint seen with losartan compared with atenolol, despite similar drops in BP, suggests that ARBs may have beneficial effects beyond BP lowering. One caveat is that, at least for now, losartan is much more expensive than is atenolol in the U.S.

— Allan S. Brett, MD

Published in Journal Watch General Medicine April 30, 2002

Citation(s):

Dahlöf B 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; 359:995-1003.

• Medline abstract (Free)

Lindholm LH et al. Cardiovascular morbidity and mortality in patients with diabetes in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): A randomised trial against atenolol. Lancet 2002 Mar 23; 359:1004-10.

• Medline abstract (Free)