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Losartan and the meaning of LIFE

Journal of Human Hypertension volume 16, pages 289–291 (2002)Cite this article

It is no longer a question of ‘should we treat’ hypertension, but ’how to treat’ and ’who to treat’. However, a recurrent argument raised by the ’traditional’ hypertensionologists and cynical clinical pharmacologists is that new antihypertensive agents are simply expensive ways of lowering blood pressure with limited evidence of a beneficial effect on prognosis—the job can equally be done by ’old’ drugs, such as the thiazide diuretics and beta-blockers, which have withstood the test of time and outcome trials. This is despite some recent views that it is time ‘to call a halt’ to beta-blocker use in hypertension.1

The new agents have also been subject to some concern. Examples include the possibility that the alpha-blocker, doxazosin, may be associated with an excess of heart failure admissions and cardiovascular events in the ALLHAT study,2 and calcium antagonist usage being involved in an excess of myocardial events.3 However, we have also had some meta-analyses, with comparisons between between new drug classes, such as ACE inhibitors4 and calcium antagonists,5,6 versus traditional regimes based on older drugs, which have showed no significant difference between the treatment arms. Hence, the rationale of large megatrials such as ALLHAT and ASCOT which are supposed to determine the differences, if any, between ‘old’ and ‘new’ antihypertensive agents. In reality, such comparisons do pose some difficulties since more than 50% of hypertensives require at least two drugs, and one-third require more than two drugs, and thus it would be difficult to dissect out a beneficial or adverse effect of a particular drug class over another—and importantly, cynical clinical pharmacologists would still remain unconvinced.

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  1. University Department of Medicine, City Hospital, Birmingham, B18 7QH, UK

    G Y H Lip

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Lip, G. Losartan and the meaning of LIFE. J Hum Hypertens 16, 289–291 (2002). https://doi.org/10.1038/sj.jhh.1001425

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