- Home>
- Specialties>
- General Medicine>
- Summary and Comment
Losartan vs. Atenolol for Isolated Systolic Hypertension
Elderly patients fared marginally better on multidrug regimens that included losartan than on regimens that included atenolol.
In a recent double-blind randomized trial, the angiotensin-receptor blocker (ARB) losartan was associated with fewer strokes than was atenolol in patients with essential hypertension and left ventricular hypertrophy (Journal Watch Apr 30 2002). Now, the same investigators report outcomes for a subset of 1326 patients (mean age, 70) with isolated systolic hypertension (160 to 200 mm Hg systolic; <90 mm Hg diastolic). The study was sponsored by the maker of losartan.
Patients received losartan or atenolol (50 to 100 mg daily); hydrochlorothiazide and other drugs were added if necessary. During a mean follow-up of 4.7 years, blood pressure was lowered equally (by about 28/9 mm Hg) in both groups. The incidence of the primary composite endpoint (cardiovascular mortality, stroke, and myocardial infarction) was lower in the losartan group than in the atenolol group (11.4% vs. 15.6%, P=0.06) -- a difference attributable to significantly lower rates of cardiovascular mortality and stroke, but not of MI, with losartan. Two secondary endpoints also occurred less frequently in the losartan group: total mortality (10% vs. 14%, P=0.046) and new-onset diabetes (5.8% vs. 9.0%, P=0.04). Significantly fewer losartan recipients than atenolol recipients withdrew from the study because of drug-related adverse events (7.1% vs. 13.5%).
Comment: In these elderly patients with isolated systolic hypertension, several differences of marginal statistical significance favored losartan over atenolol. Note, however, that this was really a comparison between multidrug regimens: Only about 10% of patients ended up on monotherapy with losartan or atenolol. Because ARBs currently are expensive in the U.S., a comparison between ARBs and diuretics or angiotensin-converting-enzyme inhibitors would be of interest for patients with systolic hypertension.
— Allan S. Brett, MD
Published in Journal Watch General Medicine October 11, 2002
Citation(s):
Kjeldsen SE et al. Effects of losartan on cardiovascular morbidity and mortality in patients with isolated systolic hypertension and left ventricular hypertrophy: A Losartan Intervention For Endpoint reduction (LIFE) substudy. JAMA 2002 Sep 25; 288:1491-8.
- Original article (Subscription may be required)
- Medline abstract (Free)