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Losartan, candesartan compare favorably at higher doses for patients with HF
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A comparison of losartan and candesartan did not reveal an increased risk for all-cause mortality when both drugs were administered at high dosage levels, according to results of a new study. However, low- and medium-dose losartan was linked to higher morality, compared with high-dose candesartan.
Data for this cohort study were obtained from nationwide registries of health and prescription records in Denmark. The final selection included 4,397 patients prescribed losartan (Cozaar, Merck; 11,347 person-years of follow-up) and 2,082 patients prescribed candesartan (Atacand, AstraZeneca; 3,675 person-years of follow-up). All patients were aged 45 years or older and had a first-time incident of HF from 1998 to 2008. Comparisons between losartan and candesartan were made at different dosage levels, and data were adjusted for variables. The study completed on Dec. 31, 2008. Follow-up for 437 patients ended early because 433 switched to another angiotensin receptor blocker and four emigrated.
Patients prescribed higher levels of either losartan (100 mg) or candesartan (16 mg to 32 mg) did not have a significantly different risk for CV-related death or death from all causes. However, those who were prescribed low doses of losartan (12.5 mg) had more than double the mortality risk compared with patients prescribed candesartan at 16 mg to 32 mg. Medium-dose losartan (50 mg) was also associated with an increased risk for death.
“This large, nationwide cohort study of patients with HF found no significantly increased risk of all-cause mortality associated with use of losartan as compared to candesartan,” researchers at the department of epidemiology research, Statens Serum Institut, Copenhagen, Denmark, said in a press release. “Whereas lower doses of losartan were associated with increased mortality risk as compared with higher doses of candesartan, there was a decreasing risk of mortality with increasing losartan dose, and no significantly increased mortality risk was observed when comparing the highest dose of losartan against the highest doses of candesartan.”
Relative to previous observational studies, the researchers said these data “provide a more detailed insight into the complexity of the association between losartan use and mortality risk in HF.”
Disclosure: Study grants were provided by the Danish Medical Research Council. The researchers report no relevant financial disclosures.
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