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Death Risk Similar With High-Dose Losartan, Candesartan

For patients with heart failure, low- or medium-dose losartan linked to increased mortality

TUESDAY, April 10 (HealthDay News) -- For patients with heart failure, the use of high-dose losartan is not associated with an increased mortality risk compared with high-dose candesartan, according to a study published in the April 11 issue of the Journal of the American Medical Association.

To compare the risk of all-cause mortality for users of losartan and candesartan, Henrik Svanström and colleagues from the Statens Serum Institut in Copenhagen, Denmark, conducted a nationwide Danish registry-based cohort study. Participants, aged 45 years and older, who were hospitalized for the first time with heart failure between 1998 and 2008, were identified from the Danish National Patient Registry and included 4,397 new users of losartan and 2,082 new users of candesartan.

Among new users of losartan, the researchers identified 1,212 deaths during 11,347 person-years of follow-up (unadjusted incidence rate [IR], 10.7 per 100 person-years). There were 330 deaths during 3,675 person-years of follow-up (unadjusted IR, 9.0 per 100 person years) for candesartan users. Losartan use was not correlated with elevated all-cause mortality (adjusted hazard ratio [HR], 1.10; 95 percent confidence interval [CI], 0.96 to 1.25), or cardiovascular mortality (adjusted HR, 1.14; 95 percent CI, 0.96 to 1.36), compared with candesartan. Compared with use of high-dose candesartan (16 to 32 mg), use of low-dose or medium-dose losartan (12.5 and 50 mg, respectively) correlated with significantly elevated mortality (HR, 2.79 and 1.39, respectively), whereas the risk was similar with use of high-dose (100 mg) losartan (HR, 0.71; 95 percent CI, 0.50 to 1.00).

"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," the authors write.

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