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February 12, 2003

Losartan vs Atenolol in Prevention of Stroke and Cardiovascular Disease

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;289(6):700-701. doi:10.1001/jama.289.6.700-a

In Reply: In response to Dr Fournier and colleagues and Dr Messerli and colleagues, we too are uncertain why losartan prevented stroke to such a greater extent than atenolol with the same level of blood pressure reduction, yet why the 2 regimens were equal in preventing myocardial infarction. Although our study did not address mechanisms, there are preclinical data in models such as the stroke-prone spontaneously hypertensive rat that show a benefit of angiotensin AT1-receptor blockade with losartan on cerebrovascular structure and prevention of cerebral lesions in the absence of an effect on blood pressure.1 In this context, AT2-receptor stimulation in addition to AT1-receptor blockade for greater selective cerebral protection seems intriguing.2 In addition, pending results of mechanistic substudies of our study may potentially shed light on the cerebrovascular protective properties of losartan.3