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Potential mechanisms of stroke benefit favoring losartan in the Losartan Intervention For Endpoint reduction in hypertension (LIFE) study.
Curr Med Res Opin. 2007 Feb; 23(2):443-57.CM

Abstract

INTRODUCTION

The Losartan Intervention For Endpoint reduction in hypertension (LIFE) study is the first, and, so far, the only endpoint trial in patients with hypertension and left ventricular hypertrophy (LVH) to show a divergent therapeutic outcome of one treatment modality over another with equivalent blood pressure control. The purpose of this article is to review post hoc sub-analyses of LIFE study data and other clinical studies that offer some insight into possible treatment-related differences contributing to the superior stroke outcome of losartan versus atenolol beyond blood pressure reduction.

METHODS

Relevant randomized clinical trials and review articles were identified through a MEDLINE search of English-language articles published between 1990 and 2006 using the search terms losartan, atenolol, LIFE, hypertension, and LVH. Articles describing major clinical studies, new data, or mechanisms pertinent to the LIFE study were selected for review.

RESULTS

Differences in blood pressure or in the distribution of add-on medications were not evident between study groups in the LIFE study. Thus, the observed outcomes benefits favoring losartan may involve other possible mechanisms, including differential effects of losartan and atenolol on LVH regression, left atrial diameter, atrial fibrillation, brain natriuretic peptide, vascular structure, thrombus formation/platelet aggregation, serum uric acid, albuminuria, new-onset diabetes, and lipid metabolism. Alternative explanations for the LIFE study findings have also been put forward, including the choice of atenolol as an appropriate active comparator and differential effects between treatment groups on central pulse pressure. Additional clinical trials are needed to determine if the beneficial effects of losartan seen in LIFE are shared by other inhibitors of the renin-angiotensin system.

CONCLUSION

Sub-analyses of the LIFE study data suggest that losartan's stroke benefit may arise from a mosaic of mechanisms rather than a single action. Further studies are expected to continue to delineate the mechanisms of differential responses to treatments in LIFE.

Authors+Show Affiliations

Greenberg Division of Cardiology, Weill Medical College of Cornell University, New York, NY 10021, USA. rbdevere@med.cornell.eduNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

17288698

Citation

Devereux, Richard B., and Björn Dahlöf. "Potential Mechanisms of Stroke Benefit Favoring Losartan in the Losartan Intervention for Endpoint Reduction in Hypertension (LIFE) Study." Current Medical Research and Opinion, vol. 23, no. 2, 2007, pp. 443-57.
Devereux RB, Dahlöf B. Potential mechanisms of stroke benefit favoring losartan in the Losartan Intervention For Endpoint reduction in hypertension (LIFE) study. Curr Med Res Opin. 2007;23(2):443-57.
Devereux, R. B., & Dahlöf, B. (2007). Potential mechanisms of stroke benefit favoring losartan in the Losartan Intervention For Endpoint reduction in hypertension (LIFE) study. Current Medical Research and Opinion, 23(2), 443-57.
Devereux RB, Dahlöf B. Potential Mechanisms of Stroke Benefit Favoring Losartan in the Losartan Intervention for Endpoint Reduction in Hypertension (LIFE) Study. Curr Med Res Opin. 2007;23(2):443-57. PubMed PMID: 17288698.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Potential mechanisms of stroke benefit favoring losartan in the Losartan Intervention For Endpoint reduction in hypertension (LIFE) study. AU - Devereux,Richard B, AU - Dahlöf,Björn, PY - 2007/2/10/pubmed PY - 2007/3/16/medline PY - 2007/2/10/entrez SP - 443 EP - 57 JF - Current medical research and opinion JO - Curr Med Res Opin VL - 23 IS - 2 N2 - INTRODUCTION: The Losartan Intervention For Endpoint reduction in hypertension (LIFE) study is the first, and, so far, the only endpoint trial in patients with hypertension and left ventricular hypertrophy (LVH) to show a divergent therapeutic outcome of one treatment modality over another with equivalent blood pressure control. The purpose of this article is to review post hoc sub-analyses of LIFE study data and other clinical studies that offer some insight into possible treatment-related differences contributing to the superior stroke outcome of losartan versus atenolol beyond blood pressure reduction. METHODS: Relevant randomized clinical trials and review articles were identified through a MEDLINE search of English-language articles published between 1990 and 2006 using the search terms losartan, atenolol, LIFE, hypertension, and LVH. Articles describing major clinical studies, new data, or mechanisms pertinent to the LIFE study were selected for review. RESULTS: Differences in blood pressure or in the distribution of add-on medications were not evident between study groups in the LIFE study. Thus, the observed outcomes benefits favoring losartan may involve other possible mechanisms, including differential effects of losartan and atenolol on LVH regression, left atrial diameter, atrial fibrillation, brain natriuretic peptide, vascular structure, thrombus formation/platelet aggregation, serum uric acid, albuminuria, new-onset diabetes, and lipid metabolism. Alternative explanations for the LIFE study findings have also been put forward, including the choice of atenolol as an appropriate active comparator and differential effects between treatment groups on central pulse pressure. Additional clinical trials are needed to determine if the beneficial effects of losartan seen in LIFE are shared by other inhibitors of the renin-angiotensin system. CONCLUSION: Sub-analyses of the LIFE study data suggest that losartan's stroke benefit may arise from a mosaic of mechanisms rather than a single action. Further studies are expected to continue to delineate the mechanisms of differential responses to treatments in LIFE. SN - 1473-4877 UR - https://www.unboundmedicine.com/medline/citation/17288698/Potential_mechanisms_of_stroke_benefit_favoring_losartan_in_the_Losartan_Intervention_For_Endpoint_reduction_in_hypertension__LIFE__study_ DB - PRIME DP - Unbound Medicine ER -