LIFE Substudy in Diabetics

27 Oct, 10

LIFE Substudy in Diabetics

Cardiovascular morbidity and mortality in patients with diabetes in the Losartan Intervention For Endpoint Reduction in hypertension study (LIFE substudy): a randomized trial against atenolol

Diabetes mellitus doubles the risk of cardiovascular disease, even in patients with hypertension who are already at high risk. Since many hypertensives develop diabetes, the combination of risk factors will account for a large proportion of cardiovascular morbidity and mortality. In the LIFE substudy, the effects of losartan and atenolol in patients with diabetes, hypertension and left ventricular hypertrophy (LVH) on the frequency of cardiovascular morbidity and mortality were compared.

If blood pressure was not controlled, then hydrochlorothiazide was added.
Groups were well balanced for treatment with antidiabetic drugs or lipid lowering drugs or aspirin.

Losartan showed a significant 24.5% reduction in risk in cardiovascular mortality, stroke and myocardial infarction as compared to atenolol.
Losartan significantly reduced cardiovascular mortality by 36.6% as compared to atenolol.
A 38.7% reduction in relative risk for total mortality was seen with losartan as compared to atenolol.
A significant 41% reduction in hospital admissions for heart failure was seen with losartan as compared to atenolol.
Losartan was more effective than atenolol in reversing LVH.

Greater percentage of patients achieved target BP in the losartan group.

Fewer discontinuations were seen with losartan than with atenolol.

Albuminuria was reported significantly less frequently with losartan (7%) than with atenolol (13%).

Conclusion

Losartan was more effective than atenolol in reducing the risk of cardiovascular morbidity and mortality as well as mortality from all causes in patients with diabetes, hypertension and LVH.
Losartan seems to have benefits beyond blood pressure reduction.
The greater cardiovascular protective effect of losartan than atenolol could result from more pronounced blockade of the detrimental effects of angiotensin II.

Lancet 2002; 359:1004-1010