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Losartan Superior to Atenolol For Reducing Cardiac Death From Arrhythmias In Hypertensive Diabetics

Hypertensive therapy with losartan affords better protection than atenolol against cardiac death from arrhythmias in patients with diabetes mellitus according to data from the Losartan Intervention For Endpoint reduction in hypertension (LIFE) study.

"Results of our post-hoc analysis showed a close to 50% risk reduction in sudden death in losartan-treated patients with diabetes compared with those treated with atenolol," writes Professor Lars H. Lindholm, MD, of Umea University Hospital, Sweden and colleagues. They studied 586 patients taking once daily losartan versus 609 patients undergoing an atenolol-based antihypertensive therapy. The patients, 53% women, were a mean age of 67 years and diabetic, with left ventricular hypertrophy and an average blood pressure of 177/96 mm Hg.

After a mean follow up of 4.7 years the researchers report that 44 patients died of sudden cardiac death, 14 (2%) in the losartan group compared with 30 (5%) in the atenolol group.

Among 191 patients with atrial fibrillation at baseline or during the trial, 10% experienced sudden cardiac death compared with 2% of the 1004 patients without atrial fibrillation. In the losartan group 5 of the 86 patients (6%) with atrial fibrillation at baseline or during the trial experienced sudden cardiac death compared with 9 of the 500 patients (2%) without atrial fibrillation. Among the atenolol group 14 of the 105 patients (13%) with atrial fibrillation compared with 16 of 504 patients (3%) without atrial fibrillation experienced sudden cardiac death.

In the losartan-treated patients the findings of reduced risk were independent of other risk factors for sudden cardiac death, but the researchers note that their analyses "were exploratory and require confirmation."

In an associated commentary Wilbert S. Aronow, MD, of Westchester Medical Center and New York Medical College, Valhalla, United States agrees that data from the LIFE trial shows the superiority of losartan over atenolol therapy for hypertensive diabetic patients with left ventricular hypertrophy. He notes however, that a large double-blind randomised trial is needed to determine whether losartan is better, similar, or worse than other beta-blockers including propranolol, timolol, metroprolol, or carvedilol in reducing sudden cardiac death and coronary events among this patient population. Such trials, Dr. Aronow adds, should stratify by risk for complex ventricular arrhythmias, atrial fibrillation, and left- ventricular ejection fraction prior to patient randomisation.
Lancet 2003;362:619-20.

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