In patients with reduced left ventricular ejection fraction (LVEF), angiotensin II receptor blockers (ARBs) have been shown to decrease cardiovascular mortality and hospital admissions for heart failure.  However, despite having different affinities for the AT1 receptor and different effects on outcomes, few ARBs have been compared head-to-head. This study aimed to compare the effects of candesartan vs losartan on all-cause mortality in patients with heart failure.

In the Swedish Heart Failure Registry of 30,254 patients, a total of 5139 were treated with candesartan (n=2,639) or losartan (n=2,500).  Survival as of December 14, 2009 was analysed by Kaplan-Meier method and multivariate analysis.  The main outcome measure was all-cause mortality at 1 and 5 years.

One-year survival was seen to be higher in patients taking candesartan (90%) than for losartan (83%), and five year survival was also higher (61% vs 44%, log rank P<0.001).  In multivariate analysis, following adjustment for propensity scores, the hazard ratio for mortality for losartan compared to candesartan was 1.43 (P<0.001).

Conclusions:

In this Swedish registry study, the use of candesartan compared to losartan was associated with a lower mortality risk both at 1 and 5 years of follow-up.

• Eklind-Cervenka M, Benson L, Dahlstrom U et al.  Association of Candesartan vs Losartan With All-Cause Mortality in Patients With Heart Failure.  JAMA. 2011;305(2):175-182