Stroke Reduction in Hypertensive Adults With Cardiac Hypertrophy Randomized to Losartan Versus Atenolol: The Losartan Intervention For Endpoint Reduction in Hypertension Study

• Published in: Hypertension (Dallas, Tex. 1979) Vol. 45; no. 1; pp. 46 - 52
• Main Authors: Kizer, Jorge R, Dahlöf, Björn, Kjeldsen, Sverre E, Julius, Stevo, Beevers, Gareth, de Faire, Ulf, Fyhrquist, Frej, Ibsen, Hans, Kristianson, Krister, Lederballe-Pedersen, Ole, Lindholm, Lars H, Nieminen, Markku S, Omvik, Per, Oparil, Suzanne, Wedel, Hans, Wachtell, Kristian, Edelman, Jonathan M, Snapinn, Steven M, Harris, Katherine E, Devereux, Richard B
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA American Heart Association, Inc 01.01.2005; Hagerstown, MD Lippincott
• Subjects: 80 and over; Aged; Aged, 80 and over; Angiotensin II Type 1 Receptor Blockers - therapeutic use; Antihypertensive agents; Antihypertensive Agents - therapeutic use; Arterial hypertension. Arterial hypotension; Atenolol - therapeutic use; Atrial Fibrillation - complications; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Cardiovascular system; Cerebrovascular Accident/epidemiology/prevention & control; Clinical manifestations. Epidemiology. Investigative techniques. Etiology; Comorbidity; Diabetes Complications; Double-Blind Method; Female; Humans; Hypercholesterolemia - complications; Hypertension - complications; Hypertension - drug therapy; Hypertension/complications/drug therapy; Hypertrophy; Hypertrophy, Left Ventricular - complications; Incidence; Left Ventricular/complications; Losartan - therapeutic use; Male; MEDICAL AND HEALTH SCIENCES; Medical sciences; MEDICIN OCH HÄLSOVETENSKAP; Middle Aged; Pharmacology. Drug treatments; Severity of Illness Index; Stroke - epidemiology; Stroke - prevention & control; Stroke/epidemiology/prevention & control; Treatment Outcome; Tetrazole derivatives; Systolic hypertension; Arrhythmia; hypertrophy; Peptide hormone; Cardiovascular disease; Non peptide compound; Vascular disease; Octapeptide; β1-Adrenergic receptor; Heart disease; Losartan; Electrocardiography; Arterial pressure; Blood pressure; clinical trials; Angiotensin II; Cerebrovascular disease; Human; Hypertension; Nervous system diseases; Stroke; drug therapy; Atrial fibrillation; angiotensin antagonists; AT1 angiotensin receptor; Atenolol; Excitability disorder; Left ventricle; Cerebral disorder; population; Treatment; Biphenyl derivatives; Central nervous system disease; Risk factor; Antihypertensive agent; Angiotensin antagonist; Comparative study; Beta blocking agent; 80 and over; Aged; Left Ventricular/complications; Hypertrophy
• ISSN: 0194-911X; 1524-4563; 1524-4563
• DOI: 10.1161/01.HYP.0000151324.05355.1c

The Losartan Intervention For Endpoint reduction in hypertension (LIFE) study showed that treatment with the angiotensin II type-1 receptor antagonist losartan reduces overall stroke risk compared with conventional therapy with the β-blocker atenolol. We conducted secondary analyses in LIFE to determine the extent to which the cerebrovascular benefits of losartan apply to different clinical subgroups and stroke subtypes and to assess the dependence of these benefits on baseline and time-varying covariates. Among 9193 hypertensive patients with electrocardiographic evidence of left ventricular hypertrophy, random allocation to losartan-based treatment lowered the risk of fatal (hazard ratio [HR], 0.65; 95% confidence interval [CI], 0.43 to 0.96; P=0.032) and atherothrombotic stroke (HR, 0.72; 95% CI, 0.59 to 0.88; P=0.001) compared with atenolol-based therapy. Although comparable risk reductions occurred for hemorrhagic and embolic stroke, these were not statistically significant. The number of neurological deficits per stroke was similar, but there were fewer strokes in the losartan group for nearly every level of stroke severity. Effects were consistent in all clinical subgroups except for those defined by age and ethnicity. The benefits of losartan on all strokes were independent of baseline and time-varying risk factors, including blood pressure. The number needed to treat for 5 years to prevent 1 stroke was 54 for the average participant, declining to 25, 24, and 9 for patients with cerebrovascular disease, isolated systolic hypertension, and atrial fibrillation, respectively. In conclusion, substantial cerebrovascular benefit could be realized with the institution of losartan-based therapy over conventional therapy among hypertensive patients with left ventricular hypertrophy across the spectrum of cardiovascular risk.