LIFE: losartan versus atenolol

As indicated in table 4 of the orginal LIFE report,2 of the enrolled population of 586 individuals initiated on losartan, only 54 (9%) ended the study still on monotherapy, and of the 609 patients initiated on atenolol, only 39 (6%) ended on monotherapy; by the end of the study most patients were on combination therapy (373 [64%] in the losartan group and 376 [62%] in the atenolol group). To conclude that losartan is better than atenolol in reducing sudden cardiac death, when there arc so few patients who were actually enrolled in a direct comparison of losartan with atenolol, is misleading. More correct, would be to conclude that the LIFE study implies that patients on a combination antihypertensive therapy, including losartan, do better than those on a combination, including atenolol.