What question did this study set out to answer?

To evaluate whether baseline albuminuria predicts cardiovascular outcomes and determines the comparative efficacy of losartan versus atenolol in hypertensive patients with left ventricular hypertrophy.

August 12, 2004Journal of Hypertension

Does albuminuria predict cardiovascular outcome on treatment with losartan versus atenolol in hypertension with left ventricular hypertrophy? A LIFE substudy

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Why the study?

Does losartan reduce cardiovascular events and albuminuria compared to atenolol in patients with hypertension and left ventricular hypertrophy?

Population

8,206 patients with hypertension and left ventricular hypertrophy

Comparison

Losartan, supplemented with diuretics and/or… vs Atenolol, supplemented with diuretics and/or…

Design

RCT, randomized, Double-blind

Follow-up

4.8 years

Authors

HIHans IbsenUppsala University KWKristian WachtellInterventional Cardiology MOMichael Hecht OlsenPreventive Cardiology

Discussion

Member takes

Implication

Supports losartan over atenolol in hypertensive LVH; confirms albuminuria reduction mediates one-fifth of CV benefit difference.

Key Points

To evaluate whether baseline albuminuria predicts cardiovascular outcomes and determines the comparative efficacy of losartan versus atenolol in hypertensive patients with left ventricular hypertrophy.
Double-blind randomized controlled trial of 8,206 hypertensive patients with left ventricular hypertrophy followed for 4.8 years in an outpatient setting.
Patients received losartan- or atenolol-based regimens supplemented with diuretics or calcium channel blockers targeting blood pressure < 140/90 mmHg.
Assessed urine albumin/creatinine ratio and the primary composite endpoint of cardiovascular death, myocardial infarction, and stroke.
Blood pressure reductions were similar between losartan (30.2/16.6 mmHg) and atenolol (29.1/16.8 mmHg), but primary composite endpoint risk increased linearly from the lowest to highest decile of baseline albuminuria.
Losartan produced a significantly greater reduction in albuminuria from baseline to year 2 compared to atenolol (33% vs. 25%), with greater benefits on primary endpoints and stroke among patients above the median baseline ratio (1.28 mg/mmol).
The greater reduction in albuminuria on losartan accounted for one-fifth (20%) of the total difference in primary composite endpoint reduction favoring losartan over atenolol.

Structured PICO

Does losartan reduce cardiovascular events and albuminuria compared to atenolol in patients with hypertension and left ventricular hypertrophy?

Population

8,206 patients with hypertension and left ventricular hypertrophy

Intervention

Losartan, supplemented with diuretics and/or calcium antagonists to reach blood pressure < 140/90 mmHg

Comparator

Atenolol, supplemented with diuretics and/or calcium antagonists to reach blood pressure < 140/90 mmHg

Outcome

Urine albumin/creatinine ratio, and the primary composite endpoint of cardiovascular death, myocardial infarction, and strokecomposite

In hypertensive patients with left ventricular hypertrophy, losartan reduces albuminuria more effectively than atenolol, a mechanism that partially explains its superior cardiovascular event reduction.

Cite This Study

Ibsen et al. (2004) studied this question.

synapsesocial.com/papers/6a7cffbfc9ada5f6b9d59ccc https://doi.org/10.1097/00004872-200409000-00026

Topics

Hypertension management

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Does albuminuria predict cardiovascular outcome on treatment with losartan versus atenolol in hypertension with left ventricular hypertrophy? A LIFE substudy

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Topics

Does albuminuria predict cardiovascular outcome on treatment with losartan versus atenolol in hypertension with left ventricular hypertrophy? A LIFE substudy

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Also Consider

Topics

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