Since US and Scandinavian researchers hypothesized that losartan was superior to atenolol in reducing cardiovascular events in a lower-risk group versus a higher-risk group of patients in a Losartan Intervention For Endpoint reduction (LIFE) substudy, independently of blood pressure (BP) reduction, in a post hoc analysis, they designated 4282 patients as lower-risk group on the basis of: (1) no previous cardiovascular disease (coronary, cerebral, peripheral vascular disease); (2) no diabetes; (3) no isolated systolic hypertension; and (4) inclusion of the lowest 3 quartiles of electrocardiographically documented left ventricular hypertrophy. The higher-risk group consisted of 4911 remaining patients who did not qualify for the lower-risk group.

They found that in the lower-risk group, losartan was superior to atenolol in reducing stroke, new-onset diabetes and new-onset atrial fibrillation, but not composite end points or cardiovascular mortality. In the higher-risk group, losartan was superior to atenolol in reducing composite end points,cardiovascular mortality, stroke, new-onset diabetes, and new-onset atrial fibrillation. Test for interaction of treatment with lower-risk group versus higher-risk group was not significant for composite end point, stroke, or atrial fibrillation, but was for cardiovascular mortality. Achieved systolic BP reduction favored losartan over atenolol by –1.8 mm Hg in lower-risk group and –0.7 mm Hg (P=0.001) in higher-risk group, but no significant differences occurred in diastolic or mean BP in either group.

The researchers concluded: “In conclusion, losartan compared with atenolol reduces the risk of stroke, new-onset diabetes, and new-onset atrial fibrillation in the lower-risk group and the higher-risk group.”

Source: Diabetes In Control.com: Hypertension. 2005;46:492. September 2005.