Candesartan associated with lower mortality rates in patients with HF vs. losartan

Eklind-Cervenka M. JAMA. 2011;305:175-182.

Issue: February 2011

Data from a registry of patients with HF have shown more favorable mortality rates at 1 and 5 years for candesartan when compared with losartan.

Study investigators analyzed patients (n=5,139) from the Swedish Heart Failure Registry, which included data from 62 hospitals and 60 outpatient clinics from 2000 to 2009. They analyzed all-cause mortality at 1 and 5 years in patients who were either taking candesartan (Atacand, AstraZeneca; n=2,639) or losartan (Cozaar, Merck; n=2,500).

At 1 year, survival was 90% in the candesartan group compared with 83% in the losartan group, and at 5 years, the mortality rate was 61% vs. 44%, also favoring the candesartan arm (log-rank P<.001). Additionally, multivariate analysis revealed an HR for mortality for losartan vs. candesartan of 1.43 (95% CI, 1.23-1.65).

Although demonstrating an association between candesartan and lower all-cause mortality when compared with losartan, “clinical decision-making should await supportive evidence of this observed association,” the researchers wrote. “Ideally, different angiotensin II receptor blocker agents should be tested against each other in randomized controlled trials. It would also be important and perhaps more feasible to confirm our findings in other large HF registries.”

The retrospective design and propensity matching of the subjects make the study interesting and hypothesis-generating. The age and year treated, in my opinion, could skew the data. Resizing this was supposedly factored out by the statistics and is less than comforting when one makes such a comparison of accepted therapies. I agree with the authors the evidence is strong enough to attempt a clinical trial with a head-to-head comparison. The difficulty comes in finding appropriate patients since angiotensin receptor blockers are recommended in HF after the ACE inhibitor has been shown to be poorly tolerated.

– Frank Smart, MD
Cardiology Today Editorial Board

Disclosure: Dr. Smart reports no relevant financial disclosures.

Follow CardiologyToday.com on Twitter.