Losartan for Heart Failure: High Dose Better Than Low

The angiotensin-receptor blocker (ARB) losartan improves heart failure outcomes better when given as a high rather than low dose, according to a manufacturer-conducted, international study in Lancet.

Some 3800 patients with heart failure, reduced left ventricular ejection fractions, and intolerance to ACE inhibitors were randomized to receive 50 mg or 150 mg of losartan daily. After nearly 5 years, the incidence of the primary composite endpoint — death or admission for heart failure — was significantly lower with 150 mg than with 50 mg of losartan (43% vs. 46%).

The higher dose was associated with more hyperkalemia, hypotension, and renal impairment, although drug discontinuation rates did not differ between the groups.

The authors say their results "show the value of up-titrating ARB doses to confer clinical benefit," while noting that their findings are not generalizable to patients who can tolerate ACE inhibitors.