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Dahlöf B, et al. Cardiovascular morbidity and mortality in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol. Lancet. 2002;359:995–1003. PMID 11937178

One-paragraph summary

LIFE randomized 9,193 adults aged 55–80 years with hypertension and electrocardiographic LVH to losartan- or atenolol-based treatment. Blood-pressure reduction was closely similar, but the losartan strategy reduced the composite of cardiovascular death, stroke, or myocardial infarction: relative risk 0.87 (95% CI 0.77–0.98). Stroke was reduced more clearly, RR 0.75 (0.63–0.89), while myocardial infarction was not. The phenotype-enriched design makes LIFE unusually relevant to HHD, although it compared treatment strategies rather than a remodeling-targeted algorithm.

Design

Element Detail
Population 9,193 adults, age 55–80, hypertension plus ECG-LVH
Intervention Losartan-based regimen
Comparator Atenolol-based regimen
Primary outcome Cardiovascular death, stroke, or myocardial infarction
Follow-up At least 4 years; mean approximately 4.8 years
Key context Similar achieved BP between strategies

Key findings

  • Primary composite: RR 0.87 (95% CI 0.77–0.98).
  • Stroke: RR 0.75 (95% CI 0.63–0.89).
  • The benefit cannot be reduced to a simple “class effect,” because add-on treatment, metabolic effects, heart rate, and tolerability differed.
  • Subsequent LIFE analyses linked electrical and echocardiographic LVH regression to lower event rates (PMIDs: 15547161, 15547162).
  • The echocardiographic substudy reported greater LV-mass-index reduction with losartan than atenolol (PMID 15326072).

Limitations

  • ECG criteria enriched for LVH but did not capture all structural HHD phenotypes.
  • Participants were older and high-risk; transfer to younger, lower-risk hypertension is uncertain.
  • Beta-blocker-first therapy is no longer the routine comparator for uncomplicated hypertension in many guidelines.
  • Similar brachial BP does not prove identical central pressure or 24-hour load.
  • Mediation by LVH regression was observational within the randomized trial.

Why it matters

LIFE is the strongest classic bridge between hypertension treatment, an explicit target-organ phenotype, remodeling, and hard outcomes. It supports treating hypertension aggressively in people with LVH and suggests that drug strategy can matter beyond clinic BP. It does not prove that serial imaging should be used as a treatment target.

Cited by wiki pages

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  • pharmacologic prevention and regression
  • outcomes and risk stratification