TUESDAY, April 10 (HealthDay News) -- Although research has
suggested that the blood pressure drug losartan (Cozaar) may be
tied to an increased risk of death in heart-failure patients
compared to a similar medication, a new study finds that's not the
"Use of this and other similar drugs has been shown to reduce morbidity and mortality in patients with heart failure," said Dr. Gregg Fonarow, co-director of the Preventative Cardiology Program at the University of California, Los Angeles, and director of the Ahmanson-UCLA Cardiomyopathy Center, commenting on the study results.
An earlier observational study in patients with heart failure
suggested that losartan was associated with higher risk of death
compared to the drug candesartan (Atacand), he said.
"There were, however, a number of limitations to this prior study that could have biased these results, including differences in dosing and treating physicians," said Fonarow, who was not involved in the studies.
The new research, conducted in Denmark, finds no meaningful
difference in survival among heart failure patients treated with
losartan or candesartan, he said.
"This study also finds for both agents that the use of higher doses, as recommended in guidelines, is associated with better outcomes than the use of lower doses," Fonarow said.
The report was published in the April 11 issue of the
Journal of the American Medical Association.
Heart failure, also called congestive heart failure, means the
heart is unable to pump blood to the rest of the body the way it
For the study, Henrik Svanstrom, from the Statens Serum
Institute in Copenhagen, and colleagues collected data on nearly
6,500 heart failure patients who had recently started taking
losartan (4,397 patients) or candesartan (2,082 patients).
Both are a type of drug called angiotensin II receptor blockers
During follow-up, 2,378 participants died -- 330 taking
candesartan and 1,212 patients taking losartan, the researchers
However, there was no significant increased risk of all-cause
death or cardiovascular death associated with losartan compared to
candesartan, the researchers said.
But dosage was important, the team said. The study found twice
the risk of death with low-dose losartan compared to high-dose
candesartan. Medium-dose losartan and low-dose candesartan also had
a higher risk of death, but high-dose losartan had no increased
death risk compared to high doses of candesartan.
"Our data provide a more detailed insight into the complexity of the association between losartan use and mortality risk in heart failure," the researchers concluded.
"These findings do not support the hypothesis of differential effects of specific ARBs in patients with heart failure," they added.
Dr. David Friedman, chief of heart failure services at North
Shore-LIJ Health System's Plainview Hospital in Plainview, N.Y.,
said, "These medications are very helpful in heart failure
Friedman noted that those in the losartan group were older and
sicker, which may explain why more of them died.
These patients could only tolerate lower doses of losartan, and
because they were sicker they were more likely to die than patients
who could tolerate higher starting doses of candesartan, he
For more on heart failure, visit the
American Heart Association.
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