Association of Treatment With Losartan vs Candesartan and Mortality Among Patients With Heart Failure

JAMA, 04/12/2012

Among patients with heart failure, overall use of losartan compared with candesartan was not associated with an increased mortality risk. Although low doses of losartan were associated with increased mortality, there was no increased mortality comparing high–dose losartan against the highest doses of candesartan.

Methods

  • The authors conducted a nationwide Danish registry–based cohort study, linking individual–level information on hospital contacts, filled prescriptions, and potential confounders.
  • Patients aged 45 years and older with first–time hospitalization for heart failure in 1998–2008 were identified from the Danish National Patient Registry.
  • New users of losartan and candesartan were selected for inclusion in the study cohort.
  • The authors used Cox proportional hazards regression to compare the risk of all–cause mortality in users of losartan and candesartan.

Results

  • Among 4397 users of losartan, 1212 deaths occurred during 11 347 person–years of follow–up (unadjusted incidence rate [IR]/100 person–years, 10.7; 95% CI, 10.1–11.3) compared with 330 deaths during 3675 person–years among 2082 users of candesartan (unadjusted IR/100 person–years, 9.0; 95% CI, 8.1–10.0).
  • Compared with candesartan, losartan was not associated with increased all–cause mortality (adjusted hazard ratio [HR], 1.10; 95% CI, 0.96–1.25) or cardiovascular mortality (adjusted HR, 1.14; 95% CI, 0.96–1.36).
  • Compared with high doses of candesartan (16–32 mg), low–dose (12.5 mg) and medium–dose losartan (50 mg) were associated with increased mortality (HR, 2.79; 95% CI, 2.19–3.55 and HR, 1.39; 95% CI, 1.11–1.73, respectively); use of high–dose losartan (100 mg) was similar in risk (HR, 0.71; 95% CI, 0.50–1.00).

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