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A growing body of data suggests that angiotensin-receptor blocker doses higher than those currently given could achieve clinical benefits in patients with heart failure. In the international, double-blind, manufacturer-sponsored and manufacturer-administered HEAAL study, 3846 patients with NYHA class II–IV heart failure symptoms, LV ejection fractions ≤40%, and intolerance to ACE inhibitors were randomly assigned to receive either 150 mg or 50 mg of losartan daily. Most patients were taking standard therapies for heart failure at enrollment, including diuretics (76%), beta-blockers (72%), and aldosterone blockers (38%).
During a median follow-up of 4.7 years, high-dose losartan significantly reduced the rate of the primary composite outcome …