CardioExchange Archive

CardioExchange, an NEJM practice community for medical professionals dedicated to improving cardiac patient care, was active from 2009 to 2015. CardioExchange fostered discussion between clinicians from across the globe.

April 11th, 2012

Study Evaluates Losartan Efficacy in Heart Failure

The angiotensin II-receptor blocker (ARB) losartan has labored under the perception that it is not as potent as other ARBs, and some evidence has suggested that it may not confer the same clinical benefits as other ARBs in heart failure patients. In a paper from Denmark published in JAMA, Henrik Svanström and colleagues performed a country-wide registry study in which they compared heart failure patients who were new users of losartan and candesartan.

Overall there were no significant differences in mortality between the two groups:

  • Adjusted hazard ratio (HR) for losartan: 1.10, CI 0.96-1.25
When compared with high-dose candesartan (16-32 mg), however, low-dose (12.5 mg) and medium-dose  (50 mg) losartan were linked to an increased risk for death, but this was not observed with high-dose (100 mg) losartan:
  • Low-dose losartan: HR 2.79, CI 2.19-3.55
  • Medium-dose losartan: HR 1.39, CI, 1.11-1.73
  • High-dose losartan: HR 0.71, CI, 0.50-1.00
The authors concluded that their “findings do not support the hypothesis of differential effects of specific ARBs in patients with heart failure.”

Categories: Heart Failure
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One Response to “Study Evaluates Losartan Efficacy in Heart Failure”

  1. Milan Kostek, MD says:
    April 13, 2012 at 2:17 pm

    As far as I know there is no registered indication for losartan in patients with heart failure. This registry with 4 397 patients is much smaller than that from Sweden with 30 254 pts whre the results are more worrying: 5-year survival was was 61% and 44% on candesartan and losartan respectively. The hazard ratio for mortality for losartan compared with candesartan was 1.43. (JAMA. 2011 Jan 12;305(2):175-82.) How come do some physicians use losartan?