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At the heart of general practice since 1960

Higher losartan doses cut deaths from heart failure

By Lara Hutchins

Increasing losartan doses from 50mg up to 150mg reduces the rate of death or admission in patients with heart failure, say North American researchers.

The HEAAL study ­ involving 3,846 patients with heart failure, left-ventricular ejection fraction 40% or less and intolerance to ACE inhibitors ­ randomly assigned patients to losartan 150mg or 50mg daily.

After a median follow-up of 4.7-years, mortality from heart failure was 43% in the 150mg group, significantly lower than the 46% in the 50mg group.

Hyperkalaemia, hypotension and renal impairment rates were higher in the 150mg cohort.

Study leader Professor Martin Konstam, director of the cardiovascular centre at the Tufts Medical Center in Boston, US, said: 'These findings show the value of uptitrating ARB doses to confer clinical benefit. The adverse events did not lead to significantly more discontinuations in the 150mg group. The outcome benefits of losartan 150mg daily have to be weighed against the adverse effects we detected with increased frequency.'

Blood pressure, serum electrolytes and renal function should be monitored carefully during ARB up-titration, and the clinical implications of any changes weighed against potential outcome benefits, he said.

Lancet 2009, online 17 November

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