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To the Editor: Dr Kjeldsen and colleagues¹ reported that among elderly individuals with isolated systolic hypertension (ISH), those treated with losartan had a nearly 50% reduction in the risk of stroke compared with those treated with atenolol. In contrast to previous results,² the effect appeared to be independent of degree of blood pressure control. There was no difference in the incidence of cardiac events, suggesting that this effect may have been mediated by the differing brain selectivities of the 2 drugs.

To estimate the whole stroke-protective effect (SPE) of losartan, estimation of atenolol-specific SPE against placebo was necessary. We do not think the authors should have used data from the SHEP (Systolic Hypertension in the Elderly Program) trial³ for that purpose, since in that trial atenolol was given only in addition to chlorthalidone. Indeed, the SPE of atenolol in elderly individuals with hypertension (with or without ISH) was estimated to . . . [Full Text of this Article]

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RELATED LETTER

Effects of Losartan on Cardiovascular Morbidity and Mortality in Patients With Isolated Systolic Hypertension and Left Ventricular Hypertrophy: A Losartan Intervention For Endpoint Reduction (LIFE) Substudy
Sverre E. Kjeldsen, Björn Dahlöf, Richard B. Devereux, Stevo Julius, Peter Aurup, Jonathan Edelman, Gareth Beevers, Ulf de Faire, Frej Fyhrquist, Hans Ibsen, Krister Kristianson, Ole Lederballe-Pedersen, Lars H. Lindholm, Markku S. Nieminen, Per Omvik, Suzanne Oparil, Steven Snapinn, Hans Wedel, and for the LIFE Study Group
JAMA. 2002;288(12):1491-1498.
ABSTRACT | FULL TEXT  

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Effects of Losartan on Cardiovascular Morbidity and Mortality in Patients With Isolated Systolic Hypertension and Left Ventricular Hypertrophy: A Losartan Intervention For Endpoint Reduction (LIFE) Substudy
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