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Losartan-Based Treatment Appears More Effective In Reducing Strokes In Hypertensives Than Atenolol-Based Treatment

Treatment with losartan-based regimens is estimated to prevent about 125,000 first strokes over 5.5 years in patients with hypertension, compared to treatment with atenolol-based regimens, reports a follow-up analysis of the Losartan Intervention for Endpoint reduction in hypertension (LIFE) study.

Previously published results of the LIFE study, a multinational study comparing the effects of losartan- to atenolol-based antihypertensive therapy on cardiovascular morbidity and mortality in patients with hypertension, showed a significant reduction in the incidence of strokes associated with losartan-based therapy.

In this current analysis, B. Dahlof, MD, Sahlgrenska University Hospital/Ostra, Goteborg, Sweden, and colleagues used data from the LIFE study to estimate the number of strokes that could be prevented with losartan-based therapy compared to atenolol-based therapy in 7.8 million patients with hypertension included in the analysis. Inclusion criteria included patients with hypertension in 15 European Union (EU) member states aged between 55 to 80 years with left ventricular hypertrophy (LVH) and no heart failure.

Estimates of the number of strokes prevented was based on multiplying the number of patients included in the analysis by the cumulative incidence risk difference in stroke at 5.5 years from the LIFE study. Using this method, the authors found a 25% reduction in the risk of stroke for patients treated with losartan-based therapy compared to those treated with atenolol-based therapy.

Over 5.5 years, the authors estimated that losartan would prevent 125,269 first strokes, with the largest number of prevented strokes seen in Germany (35,438), followed by 19,171 in Italy, 18,430 in France, 17,472 in the United Kingdom, and 12,877 in Spain.

Using a number of variables (prevalence of hypertension, LVH, or heart failure, or cumulative incidence difference of stroke between the two therapies) to test the sensitivity of this estimate, the authors found that LVH prevalence was the most sensitive variable predicting stroke prevention, with 51,246 strokes prevented based on the low-LVH estimate and 227,761 based on high-LVH estimate. The cumulative incidence difference for stroke and hypertension prevalence were the next most sensitive variables.

Based on these results, the authors conclude that "a population-side prevention strategy of using losartan in patients with LVH and hypertension has the potential to have a major public health impact in reducing the morbidity, mortality, and costs of stroke in the EU."

J Hum Hypertens 2004 Mar 18;[Epub ahead of print]. "Population impact of losartan use on stroke in the European Union (EU): Projections from the Losartan Intervention For Endpoint reduction in hypertension (LIFE) study"

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