High-Dose Is Better Than Low-Dose Losartan in Some Patients with CHF

In several studies, high-dose angiotensin-receptor blockers (ARBs), either alone or in combination with angiotensin-converting–enzyme (ACE) inhibitors, have lowered cardiovascular morbidity and mortality in patients with congestive heart failure and reduced left ventricular ejection fraction (LVEF). Because the effects of different ARB dosing regimens are unknown, manufacturer-sponsored researchers randomized 3846 patients with NYHA class II–IV CHF, LVEF ≤40%, and intolerance to ACE inhibitors to receive losartan up-titrated to either 50 mg or 150 mg daily. Most patients received other standard therapies, including β-blockers.

After a median 4.7 years of follow-up, patients who were taking high-dose losartan were significantly less likely to…