Regression of hypertensive left ventricular hypertrophy by losartan compared with atenolol: the Losartan Intervention for Endpoint Reduction in Hypertension (LIFE) trial

• BACKGROUND: An echocardiographic substudy of the Losartan Intervention for Endpoint Reduction in Hypertension (LIFE) trial was designed to test the ability of losartan to reduce left ventricular (LV) mass more than atenolol. METHODS AND RESULTS: A total of 960 patients with essential hypertension and LV hypertrophy (LVH) on screening ECG were enrolled at centers in 7 countries and studied by echocardiography at baseline and after 1, 2, 3, 4, and 5 years' randomized therapy. Clinical examination and blinded readings of echocardiograms in 457 losartan-treated and 459 atenolol-treated participants with > or =1 follow-up measurement of LV mass index (LVMI) were used in an intention-to-treat analysis. Losartan-based therapy induced greater reduction in LVMI from baseline to the last available study than atenolol with adjustment for baseline LVMI and blood pressure and in-treatment pressure (-21.7+/-21.8 versus -17.7+/-19.6 g/m2; P=0.021). Greater LVMI reduction with losartan was observed in women and men, participants >65 or <65 years of age, and with mild or more severe baseline hypertrophy. The difference between treatment arms in LVH regression was due mainly to reduced concentricity of LV geometry in both groups and lesser increase in LV internal diameter in losartan-treated patients. CONCLUSIONS: Antihypertensive treatment with losartan, plus hydrochlorothiazide and other medications when needed for pressure control, resulted in greater LVH regression in patients with ECG LVH than conventional atenolol-based treatment. Thus, angiotensin receptor antagonism by losartan has superior efficacy for reversing LVH, a cardinal manifestation of hypertensive target organ damage.

Nyckelord

Adrenergic beta-Antagonists/*therapeutic use

Aged

Aged

80 and over

Angiotensin II Type 1 Receptor Blockers/*therapeutic use

Antihypertensive Agents/therapeutic use

Atenolol/*therapeutic use

Blood Pressure/drug effects

Double-Blind Method

Female

Follow-Up Studies

Heart Rate/drug effects

Heart Ventricles/drug effects/pathology/ultrasonography

Humans

Hypertension/*complications/drug therapy

Hypertrophy

Left Ventricular/*drug therapy/etiology/ultrasonography

Losartan/*therapeutic use

Male

Middle Aged

Organ Size

Prospective Studies

Treatment Outcome

Publikations- och innehållstyp

ref (ämneskategori)

art (ämneskategori)