Patients with isolated systolic hypertension and left ventricular hypertrophy may benefit more from losartan than from atenolol, according to an article in the September 25th issue of The Journal of the American Medical Association (JAMA).

Sverre E. Kjeldsen, M.D., and colleagues set out to test a hypothesis that losartan would improve outcome more than atenolol in patients with isolated systolic hypertension and electrocardiographic evidence of left ventricular hypertrophy.

A total of 1,326 men and women aged 55 to 80 years participated in the study at 945 outpatient settings in Scandinavia, the United Kingdom, and the United States. The patients had a systolic blood pressure of 160 to 200 mm Hg and diastolic blood pressure of less than 90 mm Hg. The participants were a subgroup of the larger Losartan Intervention For Endpoint Reduction Study (LIFE Study) designed in the early 1990s.

The 1,326 people were randomized to once-daily losartan (n = 660) or atenolol (n = 666), with hydrochlorothiazide as the second agent in both groups; they were followed for almost five years.

Researchers found that both losartan and atenolol reduced blood pressure. The incidence of cardiovascular death, stroke, or myocardial infarction was reduced by 25 percent with losartan compared with atenolol (25.1 versus 35.4 events per 1,000 patient years).

"It appears that in non-isolated systolic hypertension patients, the main findings are reduced stroke and new-onset diabetes, while in isolated systolic hypertension patients losartan also lowers cardiovascular death and all-cause death," the authors report.

The authors conclude that "Losartan-based antihypertensive therapy was more effective than an atenolol-based treatment in preventing cardiovascular morbidity and mortality, especially stroke and cardiovascular death, in a large pre-specified subset of [LIFE] participants with left ventricular hypertrophy on their electrocardiograms and [isolated systolic hypertension. In addition, losartan was associated with a lower incidence of new-onset diabetes and lower total mortality. It is currently not known whether losartan is superior to diuretics or calcium channel blockers as a first-line treatment of isolated systolic hypertension."