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 case.
“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 should.
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
(ARBs).
During follow-up, 2,378 participants died — 330 taking candesartan and
1,212 patients taking losartan, the researchers found.
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 patients.”
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 said.
More information
For more on heart failure, visit the American Heart Association.
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