Use of losartan, mainly used as antihypertensive agent, compared with candesartan for heart failure (HF) is not associated with an increased mortality risk, study findings show. “Although low doses of losartan were associated with increased mortality, there was no increased mortality comparing high-dose losartan against the highest doses of candesartan,” report Henrik Svanström (Statens Serum Institute, Copenhagen, Denmark) and colleagues in the Journal of the American Medical Association issued in April 11.
They conducted a nationwide cohort study that involved patients aged 45 years or older from the Danish National Patient Registry with first-time hospitalization for heart failure (HF), who initiated treatment with candesartan or losartan between 1998 and 2008. These participants were linked to individual-level information on hospital contacts, drug use, and potential confounders. The findings revealed that among 4397 users of losartan, 1212 deaths occurred during 11,347 person–years of follow-up, at an unadjusted incidence rate of 10.7, compared with 330 deaths during 3675 person–years among 2082 users of candesartan, at an incidence rate of 9.0. Compared with candesartan, losartan was not significantly associated with increased all-cause mortality or cardiovascular mortality. In addition, comparing to the group used candesartan, there was no significant link between losartan and increased mortality risk.
Further analysis revealed that compared with high-dose candesartan (16–32 mg), low-dose (12.5 mg) and medium-dose (50 mg) losartan were significantly associated with increased all-cause mortality, at hazard ratios of 2 or higher, respectively. Interestingly, high-dose losartan (100 mg) and high-dose candesartan were associated with a similar risk for all-cause mortality.
“These findings do not support the hypothesis of differential effects of specific angiotensin-receptor blockers in patients with HF,” conclude the authors.
Date: April 11, 2012