Comparison of medications for heart failure finds difference in risk of death

January 11, 2011, JAMA and Archives Journals

In a comparison of the angiotensin II receptor blockers (ARBs) candesartan and losartan, used by patients with heart failure, candesartan was associated with a lower risk of death at 1 and 5 years, according to a study in the January 12 issue of JAMA.

Angiotensin II receptor blockers reduce and heart failure (HF) hospitalization in patients with HF with reduced left ventricular ejection fraction (LVEF; a measure of how well the left ventricle of the heart pumps with each contraction). Despite variable effects of different ARBs, they have not been tested head to head, and there are reasons to believe they may differ in efficacy, according to background information in the article. Previous research found that in with HF, losartan was associated with higher mortality than other ARBs.

Maria Eklind-Cervenka, M.D., of the Department of Cardiology, South Hospital, Stockholm, and colleagues conducted a study to determine whether candesartan is associated with less all-cause mortality than losartan in patients with HF. The study included analysis of data from an HF registry (the Swedish Registry) of 30,254 patients registered from 62 hospitals and 60 outpatient clinics between 2000 and 2009. A total of 5,139 patients (average age, 74; 39 percent women) were treated with candesartan (n = 2,639) or losartan (n = 2,500).

In overall survival between the 2 groups, the researchers found that one-year survival was 90 percent for patients receiving candesartan and 83 percent for patients receiving losartan, and 5-year survival was 61 percent for patients receiving candesartan and 44 percent for patients receiving losartan. The results persisted in stratified analyses.

The researchers add that there are mechanistic reasons to believe candesartan may be more effective than losartan and that studies of candesartan have been larger and more conclusively positive than studies of losartan.

"In conclusion, our findings suggest that candesartan is associated with less all-cause mortality than losartan. However, clinical decision making should await supportive evidence of this observed association. Ideally, different ARB 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 authors write.

More information: JAMA. 2011;305[2]:175-182.

Related Stories

Recommended for you

Study reveals how kidney disease happens

February 22, 2018
Monash researchers have solved a mystery, revealing how certain immune cells work together to instigate autoimmune kidney disease.

Past encounters with the flu shape vaccine response

February 20, 2018
New research on why the influenza vaccine was only modestly effective in recent years shows that immune history with the flu influences a person's response to the vaccine.

Building better tiny kidneys to test drugs and help people avoid dialysis

February 16, 2018
A free online kidney atlas built by USC researchers empowers stem cell scientists everywhere to generate more human-like tiny kidneys for testing new drugs and creating renal replacement therapies.

Study suggests expanded range for emerging tick-borne disease

February 16, 2018
Human cases of Borrelia miyamotoi, a tick-borne infection with some similarities to Lyme disease, were discovered in the eastern United States less than a decade ago. Now new research led by the Yale School of Public Health ...

Expanding Hepatitis C testing to all adults is cost-effective and improves outcomes

February 16, 2018
According to a new study, screening all adults for hepatitis C (HCV) is a cost-effective way to improve clinical outcomes of HCV and identify more infected people compared to current recommendations. Using a simulation model, ...

Flu shot only 36 percent effective, making bad year worse (Update)

February 15, 2018
The flu vaccine is doing a poor job protecting older Americans and others against the bug that's causing most illnesses.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.