The Presenter:

A randomized, double-blind, parallel group study of losartan (a selective angiotensin I receptor blocker)–based versus atenolol-based therapy in 9193 patients with essential hyper-tension and ECG evidence of left ventricular hypertrophy (LVH).1 To base therapy (both up to a maximum of 100 mg), diuretics and other antihypertensive agents (excluding angio-tensin-converting enzyme inhibitors, other angiotensin recep-tor blockers, or -blockers) could be added. Study therapy was continued for 4 years; the primary end point was the composite of cardiovascular mortality, stroke, and myocar-dial infarction. The Results: The degree of blood pressure control was similar between groups. There were significantly fewer cardiovascular events in the losartan group (11 % versus 13%, P0.021), and the primary difference was a reduction in the number of strokes (5 % versus 7%, P0.001). Regression of LVH on the ECG was also significantly more frequent with losartan. Intrigu-ingly, with losartan, there was a 25 % reduction in the number of patients who developed diabetes, and in the subgroup of patients with diabetes, total mortality was reduced by 39%. Summary: In hypertensive patients with ECG evidence of LVH, out-comes with losartan are significantly better than with ateno-lol. This benefit is particularly manifested in patients with diabetes. It is also worth noting that the likelihood of developing diabetes was also reduced with losartan