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Losartan reduced strokes and new onset diabetes more than atenolol in essential hypertension

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 QUESTION: In patients with essential hypertension and signs of left ventricular hypertrophy (LVH), is losartan-based therapy more effective than atenolol-based therapy?


Randomised (unclear allocation concealment*), blinded (patients and monitoring committee),* controlled trial with ≥4 years follow-up.


Multicentre trial in Europe and the United States.


9222 patients 55 to 80 years of age (mean age 67 y, 54% women) with hypertension (sitting blood pressure [BP] after 1 to 2 wks of placebo of 160 to 200 mm Hg systolic, 95 to 115 mm Hg diastolic, or both) and electrocardiographical signs of LVH. Exclusion criteria included secondary hypertension; myocardial infarction (MI) or stroke within the previous 6 months; angina pectoris requiring treatment with β-blockers or calcium antagonists; and heart failure or left ventricular ejection fraction ≤40%. Follow-up was 99%.


Patients were allocated to losartan based therapy (n = 4605) or atenolol based therapy (n = 4588). Losartan and atenolol were started at 50 mg/day, combined with low dose hydrochlorothiazide if needed and …

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