1. ¹Ullevaal University Hospital, Oslo, Norway
2. ²University of Michigan Hospital, Ann Arbor, MI, USA
3. ³Merck Research Laboratories, West Point, PA, USA
4. ⁴Sahlgrenska University Hospital/Östra, Göteborg, Sweden
5. ⁵Cornell Medical Center, New York, NY, USA
6. ⁶City Hospital, Birmingham, UK
7. ⁷Karolinska University Hospital, Stockholm, Sweden
8. ⁸Helsinki University Central Hospital, Finland
9. ⁹Glostrup University Hospital, Denmark
10. ¹⁰Merck Research Laboratories Scandinavia, Stockholm, Sweden
11. ¹¹Viborg Hospital, Denmark
12. ¹²Umeå University, Sweden
13. ¹³Haukeland University Hospital, Bergen, Norway
14. ¹⁴University of Alabama, Birmingham, AL, USA
15. ¹⁵The Nordic School of Public Health, Göteborg, Sweden

Correspondence: Dr HM Reims, Department of Cardiology, Ullevaal University Hospital, Kirkeveien 166, N-0407 Oslo, Norway. E-mail: henrik.reims@ioks.uio.no

Abstract

The Losartan Intervention For End point reduction in hypertension (LIFE) study showed superiority of losartan over atenolol for reduction of composite risk of cardiovascular death, stroke, and myocardial infarction in hypertensives with left ventricular hypertrophy. We compared hazard ratios (HR) in 4287 and 685 participants who reported intakes of 1–7 and >8 drinks/week at baseline, respectively, with those in 4216 abstainers, adjusting for gender, age, smoking, exercise, and race. Within categories, clinical baseline characteristics, numbers randomized to losartan and atenolol, and blood pressure (BP) lowering were similar on the drug regimens. Overall BP control (<140/90 mmHg) at end of follow-up was similar in the categories. Composite end point rate was lower with 1–7 (24/1000 years; HR 0.87, P<0.05) and >8 drinks/week (26/1000 years; HR 0.80, NS) than in abstainers (27/1000 years). Myocardial infarction risk was reduced in both drinking categories (HR 0.76, P<0.05 and HR 0.29, P<0.001, respectively), while stroke risk tended to increase with >8 drinks/week (HR 1.21, NS). Composite risk was significantly reduced with losartan compared to atenolol only in abstainers (HR 0.81 95% confidence interval, CI (0.68, 0.96), P<0.05), while benefits for stroke risk reduction were similar among participants consuming 1–7 drinks/week (HR 0.73, P<0.05) and abstainers (HR 0.72, P<0.01). Despite different treatment benefits, alcohol-treatment interactions were nonsignificant. In conclusion, moderate alcohol consumption does not change the marked stroke risk reduction with losartan compared to atenolol in high-risk hypertensives. Alcohol reduces the risk of myocardial infarction, while the risk of stroke tends to increase with high intake.