Stroke outcomes in life

LIFE was a multinational cardiovascular event outcomes study that assigned 9,193 patients with hypertension and electrocardiographic evidence of left ventricular hypertrophy to randomized, double-blind treatment with a regimen based on either losatan or atenolol. The primary endpoint was a composite of cardiovascular death, myocardial infarction, and stroke. Blood pressure was reduced substantially and similarly in both groups during an average of 4.8 years follow-up. The losartan group experienced a reduction in the composite endpoint of 13% (hazard ratio [HR]=0.87, 95% confidence interval [CI]=0.77–0.98, P=0.021), and in fatal and nonfatal strokes of 25% (HR=0.75, 95% CI=0.63–0.89, P=0.001) compared with the atenolol group. In a qualitative subgroup analysis, the incidence of fatal and nonfatal strokes in patients with isolated systolic hypertension, diabetes mellitus, or history of cardiovascular disease was increased compared with patients without these disease. Blacks had an increased rate of strokes compared with nonblacks. Losartan was more effective than atenolol in preventing strokes in patients with isolated systolic hypertension (HR=0.60, 95% CI=0.38–0.92), diabetes (HR=0.79, 95% CI=0.55–1.14), and history of cardiovascular disease (HR=0.84, 95% CI=0.65–1.10), but not in black patients (HR=2.18, 95% CI=1.08–4.40). Consistent with the results seen in the overall population, a reduction in stroke was an important contributor to the benefit in the composite outcome observed in patients with diabetes or isolated systolic hypertension. The LIFE study suggests that the mechanism of stroke prevention with losartan extends beyond its blood-pressure-lowering effects.