Association of candesartan vs losartan with all-cause mortality in patients with heart failure.

CONTEXT: Angiotensin II receptor blockers (ARBs) reduce combined mortality and hospitalization in patients with heart failure (HF) with reduced left ventricular ejection fraction. Different agents have different affinity for the AT(1) receptor and may have different clinical effects, but have not been tested against each other in HF.

OBJECTIVE: To assess the association of candesartan vs losartan with all-cause mortality in patients with HF.

DESIGN, SETTING, AND PATIENTS: An HF registry (the Swedish Heart Failure Registry) of 30,254 unique patients registered from 62 hospitals and 60 outpatient clinics between 2000 and 2009. A total of 5139 patients (mean [SD] age, 74 [11] years; 39% women) were treated with candesartan (n = 2639) or losartan (n = 2500). Survival as of December 14, 2009, by ARB agent was analyzed by Kaplan-Meier method and predictors of survival determined by univariate and multivariate proportional hazard regression models, with and without adjustment for propensity scores and interactions. Stratified analyses and quantification of residual confounding were also performed.

MAIN OUTCOME MEASURES: All-cause mortality at 1 and 5 years.

RESULTS: One-year survival was 90% (95% confidence interval [CI], 89%-91%) for patients receiving candesartan and 83% (95% CI, 81%-84%) for patients receiving losartan, and 5-year survival was 61% (95% CI, 54%-68%) and 44% (95% CI, 41%-48%), respectively (log-rank P < .001). In multivariate analysis with adjustment for propensity scores, the hazard ratio for mortality for losartan compared with candesartan was 1.43 (95% CI, 1.23-1.65; P < .001). The results persisted in stratified analyses.

CONCLUSION: In this registry of patients with HF, the use of candesartan compared with losartan was associated with a lower mortality risk.