Rational antihypertensive therapy: a reduced risk for cardiovascular events is not only the result of blood pressure lowering: results of the LIFE study

To lower blood pressure (BP) and its properly further maintenance are a main goal of antihypertensive therapy. Many large studies have provided strong evidence that there is an association of elevated BP with a risk for cardiovascular events (CVE), such as stroke, (S), myocardial infarction (MI), and heart failure (HF). But none of the studies has indicated that a drug is more effective than another one in reducing the risk for CVE and death. A recent LIFE study has demonstrated the indisputable advantage of the angiotensin II receptor blocker (ARB) of the first type losar-tan over the ß-blocker atenolol in patients with arterial hypertension and left ventricular hypertrophy (LVH). The study covered 9193 patients aged 55 to 80 years who had a diastolic BP of 95-115 mm Hg or a systolic BP of 160-220 mm Hg and ECG signs of LVH. The study was double-blind, randomized, and parallel. The patients received either losartan in a daily dose of 50-100 mg or atenolol in the same daily dose; if the target BP (< 140/90 mm Hg) was not achieved, hydrochlorthiazide and other antihypertensive drugs could be supplemented. The study lasted about 4 years. It revealed that the use of losartran caused a reduction in a relative risk for cardiovascular death by 11 %, MI by 25%, new cases of diabetes mellitus by 25% as compared to therapy based on the ß-blocker atenolol.