Interpretation:

This trial showed a beneficial effect with regard to regression of LVH and fewer cardiovascular events, strokes and onset of diabetes in the subgroup of elderly patients with systolic hypertension enrolled in the LIFE trial. No data were presented regarding absolute reductions in blood pressure in each group, and based on these data, it is unknown whether the benefit of losartan is independent of the blood pressure lowering effect. In so far as losartan may be better tolerated than atenolol, and because losartan in this subgroup may be more beneficial, losartan can be considered as an alternative to atenolol for systolic hypertension in the elderly. The known synergistic effect of HCTZ with angiotensin II receptor antagonists in reducing blood pressure may have led to additional benefit and such an effect has not been demonstrated with atenolol. While the composite endpoint difference did not reach statistical significance, such a difference favoring losartan may have been detected if a greater number of events were larger. Based on these findings, it is unclear if these benefits can be generalized to patients with systolic and diastolic hypertension, younger age or no LVH. While these substudy data are provocative, further prospective data validating these findings is lacking at present.