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April 20, 2011

Candesartan vs Losartan and Mortality in Patients With Heart Failure

JAMA. 2011;305(15):1540-1542. doi:10.1001/jama.2011.463

To the Editor: The claim made in the study by Dr Eklind-Cervenka and colleagues1 that candesartan was associated with a lower mortality risk than losartan in patients with HF needs additional substantiation before it can be accepted as valid. The issue relates to the doses of losartan. A previous study reported a better outcome in patients with HF given 150 mg of losartan each day compared with those given 50 mg per day.2 The doses given to those receiving losartan were ambiguous in the study by Eklind-Cervenka et al. It appears that the dose was initially titrated to 50 mg and later in the trial to 150 mg, although a large percentage of patients did not receive the full dose at either time. The representation of doses and number of patients as shown in Table 2 are difficult to understand. Before a claim is made for the superiority of candesartan, the provision of a therapeutically equal dose of losartan will have to be shown.