Use of high blood pressure medication by heart failure patients does not appear to increase mortality

Taken from the Journal of the American Medical Association (JAMA) – by Bruce Sylvester – A registry study including data on nearly 6,500 patients shows that use of losartan by heart failure patients is not associated with increased all-cause death or cardiovascular death when compared with use of the ARB candesartan.

The findings were published in the April 11 issue of JAMA.

The investigators noted that the new analysis was prompted by prior observational studies suggesting that losartan, used primarily to treat hypertension, might be associated with an increased risk of death among patients with heart failure compared with other medications in the same class of drugs (angiotensin II receptor blockers [ARBs]).

Henrik Svanström, M.Sc., of Statens Serum Institut, Copenhagen, Denmark, and colleagues evaluated included data from a nationwide Danish registry.

They identified subjects ages 45 years and older with first-time hospitalization for heart failure in 1998-2008. New users of losartan and candesartan were selected for inclusion in the analysis.

The final study group included 6,479 subjects, 2,082 users of candesartan and 4,397 users of losartan.

During follow-up, there were 2,378 deaths, with 330 happening during ongoing candesartan use and 1,212 during ongoing losartan use.

The investigators found no statistically significantly increased risk of death with losartan compared to candesartan. Also, losartan was not significantly associated with an increased risk of cardiovascular mortality compared with candesartan..

Notably, they found that use of low-dose losartan (12.5 mg) associated with a more than doubled increased risk of mortality as compared with high doses of candesartan (16-32 mg). Treatment with 50 mg of losartan was also associated with a higher mortality risk. But, they found was no increased risk associated with use of 100 mg of losartan.

The authors wrote that compared with previous observational studies, “our data provide a more detailed insight into the complexity of the association between losartan use and mortality risk in heart failure.”

They concluded, “This large, nationwide cohort study of patients with heart failure found no significantly increased risk of all-cause mortality associated with use of losartan as compared with candesartan. 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; and no significantly increased mortality risk was observed when comparing the highest dose of losartan against the highest doses of candesartan. These findings do not support the hypothesis of differential effects of specific ARBs in patients with heart failure.”