What is the clinical evidence from this study?

Study design: RCT. Population: Systemic hypertension (n=50). Intervention: Losartan vs. ACE inhibitors (enalapril or imidapril) and no-RAS-inhibitor control. Primary outcome: Change in intima-media thickness (IMT) of the common carotid artery.

January 1, 2008Open Access

A One-Year Study of the Antiatherosclerotic Effect of the Angiotensin-II Receptor Blocker Losartan in Hypertensive Patients A Comparison With Angiotensin-Converting Enzyme Inhibitors

Key Result

Losartan reduced the intima-media thickness of the common carotid artery by 0.078 mm over 12 months, demonstrating an antiatherosclerotic effect comparable to that of ACE inhibitors.

Study Design

Type

RCT (n=50)

Blinding

Open-label

Randomization

Minimization method

Structured PICO

Does losartan reduce carotid intima-media thickness compared to ACE inhibitors or control in hypertensive patients?

Population

50 patients with systemic hypertension, excluding those with renal failure, followed for 12 months to compare the antiatherosclerotic effects of losartan and ACE inhibitors.

Intervention

Losartan 50 mg/day for approximately 12 months

Comparator

ACE inhibitor (enalapril 5 mg/day or imidapril 5 mg/day) or a control group receiving neither an ARB nor an ACE inhibitor

Outcome

Change in intima-media thickness (IMT) of the common carotid artery measured by B-mode ultrasound after approximately 12 months of treatmentsurrogate

Losartan 50 mg/day significantly reduces carotid intima-media thickness to a similar extent as ACE inhibitors in hypertensive patients, but with fewer adverse effects like cough.

Main Result

Absolute Event Rate: -0.078% vs -0.073%

Limitations

More than one ACE inhibitor was used as a comparator
The number of patients in the losartan group was greater than that of the ACE inhibitor group
Small sample size requiring larger scale future studies

Abstract

Angiotensin receptor blockers (ARB) have been emerging as drugs to treat atherosclerosis. The effectiveness of the ARB losartan at reducing atherosclerosis was compared with that of ACE inhibitors in hypertensive patients. A total of 50 patients with hypertension were divided into 3 groups: a control group receiving neither an ARB nor an ACE inhibitor (n = 14), a losartan group (n = 22) receiving 50 mg/day of losartan, and an ACE inhibitor group (n = 14) receiving either 5 mg/day of enalapril or 5 mg/day of imidapril. Atherosclerosis was evaluated based on the intima-media thickness (IMT) of the common carotid artery measured by B-mode ultrasound at baseline and after approximately 12 months of treatment. After the treatment, IMT significantly decreased with losartan (from 0.87 +/- 0.14 to 0.79 +/- 0.16 mm, P < 0.05) and with ACE inhibitor (from 0.81 +/- 0.14 to 0.74 +/- 0.11 mm, P < 0.05). The reduction was comparable between the two groups, -0.078 +/- 0.136 with losartan and -0.073 +/- 0.109 mm with ACE inhibitor, and the rate of the reduction was similar between the two drugs; -0.098 +/- 0.142 mm/year with losartan and (-0.076 +/- 0.118 mm/year) with ACE inhibitor. On the contrary, IMT did not change in the control group (from 0.90 +/- 0.20 to 0.95 +/- 0.26 mm) during the treatment period. Concomitant medication and coronary risk factors such as hyperlipidemia, diabetes mellitus, and smoking did not differ significantly among the groups. The antiatherosclerotic effect of losartan on the carotid artery was comparable to that of ACE-inhibitors, and less adverse effects, such as coughing that occurs with ACE inhibitors, were observed. Losartan appears to be a better alternative to ACE inhibitors for treating atherosclerosis in Japanese hypertensive patients.

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