Is Losartan as Good as Candesartan for HF?

Angiotensin-receptor blockers (ARBs) are recommended for patients with heart failure (HF) and left ventricular systolic dysfunction who do not tolerate angiotensin-converting enzyme inhibitors. Although the recommendation assumes a class effect of ARBs, some observational data suggest that, compared with other ARBs, losartan is associated with higher mortality in HF patients.

In an analysis of Danish National Patient Registry data, investigators identified 6479 individuals aged 45 or older (mean age, 72; 55% men; left ventricular ejection fractions unknown) who were hospitalized with HF during 1998–2008 and who had not received an ARB within the previous 3 years. They compared outcomes in losartan recipients with those in candesartan recipients.

Unadjusted all-cause mortality was higher with losartan (10.7 per 100 person-years) than with candesartan (9.0 per 100 person-years); however, after multivariable adjustment, neither all-cause nor cardiovascular mortality differed significantly between the two groups. Compared with high doses of candesartan, the risk for death was significantly higher in patients receiving low or intermediate doses of losartan (hazard ratios, 2.79 and 1.39, respectively) or low doses of candesartan (HR, 2.12).