Use of the angiotensin receptor blocker (ARB) candesartan was associated with a lower mortality than losartan in a Swedish registry of heart failure patients.
The registry study, published in Journal of the American Medical Association (January 12th, 2011 issue), involved 30,254 patients, of whom 2,500 were taking losartan and 2,639 were taking candesartan. One-year survival was 90% for patients receiving candesartan and 83% for those taking losartan. Five-year survival was 61% and 44%, respectively. In multivariate analysis with adjustment for propensity scores, the hazard ratio for mortality for losartan compared with candesartan was 1.43 (p<0.001).
The authors, led by Dr Maria Eklind-Cervenka (South Hospital, Stockholm, Sweden) note that the difference remained significant even after adjustment for propensity scores and numerous clinical variables, including dose and potential interactions, as well as after stratification and quantification of potential residual confounding “of a reasonable magnitude”.
They concede that some confounding could still be present and that the findngs need to be confirmed with head-to-head trials or other large heart failure registries. “Clinical decision making should await supportive evidence of this observed association,” they conclude.