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LIFE and SCOPE: what guidance do they offer alongside ALLHAT and ANBP2?

Journal of Human Hypertension volume 18, pages 295–300 (2004)Cite this article

The benefits of reducing blood pressure in patients with essential hypertension are not in dispute. The question is how best to lower the pressure with drugs if lifestyle changes alone prove unsuccessful. It has been a matter of debate as to whether the various groups of antihypertensive drug classes have the same or different effects on cardiovascular morbidity and mortality. Interpretration of head-to-head studies can be difficult since, for example, achieved blood pressures between treatment groups have sometimes been discrepant, studies have been underpowered or of brief duration, the diagnosis of end points (heart failure in particular) has lacked objectivity and withdrawal rates from therapy were sometimes high. Combining data from individual studies in meta-analyses has the potential to clarify some issues but, unless performed with clear forethought and exactitude, can confuse an already complex situation.1 With this caveat in mind, a recent overview of antihypertensive drug trials by the Blood Pressure Lowering Treatment Trialsts’ Collaboration2 found no convincing evidence for differences in cardiovascular outcomes between treatment regimens for essential hypertension based on different drug classes (ACE inhibitors, calcium channel blockers or diuretics and beta-blockers).

Two recent studies have reported on the angiotensin II receptor antagonists (AIIAs): the Losartan Intervention For Endpoint reduction study (LIFE)3 and the Study on Cognition and Prognosis in the Elderly (SCOPE).4 In this article, LIFE and SCOPE are considered along with results from ANBP2 (Second Australian National Blood Pressure Study)5 and ALLHAT (Antihypertensive and Lipid Lowering to prevent Heart Attack Trial),6 which were published around the same time as LIFE and SCOPE, to determine what guidance they provide for the drug treatment of essential hypertension. The emphasis is on drugs that block the renin–angiotensin system, the AIIAs in particular.

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Authors and Affiliations

  1. Department of Internal Medicine, Faculty of Medicine and Health Sciences, United Arab Emirates University, PO Box 17666, Al Ain, United Arab Emirates

    M G Nicholls

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Nicholls, M. LIFE and SCOPE: what guidance do they offer alongside ALLHAT and ANBP2?. J Hum Hypertens 18, 295–300 (2004). https://doi.org/10.1038/sj.jhh.1001675

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