January 11th, 2011
Candesartan Beats Losartan in Swedish HF Registry
The Swedish Heart Failure Registry followed more than 5,000 patients treated with the angiotensin II receptor blockers (ARBs) candesartan or losartan between 2000 and 2009. According to a paper published in JAMA, survival at one year was 90% in the candesartan group compared to 83% in the losartan group. Five-year survival was 61% and 44%. After adjustment for clinical differences and propensity scores, the hazard ratio for losartan compared to candesartan was 1.43.
Discussing the large difference between the drugs, the authors acknowledge that “the magnitude of our findings may be due to chance, but RCTs may understate ‘real world’ differences, and it is conceivable that candesartan is better than losartan by a magnitude similar to placebo.” They conclude, however, that “clinical decision making should await supportive evidence” and recommend that differences between ARBs should be tested in randomized trials, though they acknowledge it may be more feasible to confirm the finding in other registries.