[The effect of losartan versus atenolol on cardiovascular morbidity and mortality in patients with diabetes mellitus in the LIFE-study]

Author(s): Ibsen H, Lindholm LH, Pedersen OL, Dahlof B, Kjeldsen S

Affiliation(s): Medicinsk Afdeling M, Amtssygehuset i Glostrup, DK-2600 Glostrup.

Publication date & source: 2003-01-27, Ugeskr Laeger., 165(5):459-62.

Publication type: Clinical Trial; Randomized Controlled Trial

INTRODUCTION: The most suitable antihypertensive drug to reduce the risk of cardiovascular disease in patients with hypertension and diabetes is unclear. In a prespecified analysis of the LIFE-study we compared the effects of losartan and atenolol on cardiovascular morbidity and mortality in diabetic patients. MATERIAL AND METHODS: A total of 1195 patients in the LIFE-study had diabetes at the time of the randomisation. The patients were randomised for double-blind treatment with losartan versus atenolol. The patients had ECG-verified left ventricular hypertrophy, mean age 67 years, blood pressure 177/96 mmHg after two weeks placebo run-in period. Patients were followed for at least four years (mean 4.7 years). The primary composite endpoint was cardiovascular death, stroke or myocardial infarction. RESULTS: Blood pressure was reduced to 146/79 and 148/79 in losartan-treated patients and atenolol-treated patients, respectively. The primary endpoint occurred in 103 patients assigned losartan (n = 586) and 139 assigned atenolol (n = 609). Relative risk reduction 24% (p < 0.031). Cardiovascular mortality was reduced by 37% in favour of losartan (p < 0.028), and all cause mortality by 39% (p < 0.002). DISCUSSION: Losartan was very effective in reducing cardiovascular morbidity and mortality as compared to atenolol. These results will have a major impact on the choice of anti-hypertensive treatment for patients with hypertension and diabetes.