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Evidence summaries

Losartan or Captopril for Symptomatic Heart Failure

Losartan appears to be no better than captopril in improving survival in elderly heart failure patients. Losartan may cause less adverse effects, particularly cough. Level of evidence: "B"

The ELITE II study 1 randomised 3152 patients with NYHA class II - IV heart failure and ejection fraction of 40% or less to receive either losartan titrated to 50 mg once daily or captopril titrated to 50 mg three times daily. The median follow-up time was 555 days. There were no significant differences in all-cause mortality (11.7 bs 10.4% average annual mortality rate) or sudden death or resuscitation arrests (9.0% vs 7.3%) between the two treatment groups. Significantly fewer patients in the losartan group (excluding those who died) discontinued study treatment because of adverse effects (9.7 vs 14.7%, p<0.001) including cough (0.3 vs 2.7%).

Comment: The quality of evidence is downgraded by inconsistency (variability in results across studies; the superiority of losartan suggested by ELITE I study based on secondary analysis was not supported in this trial).

    References

    • Pitt B, Poole-Wilson PA, Segal R, Martinez FA, Dickstein K, Camm AJ, Konstam MA, Riegger G, Klinger GH, Neaton J, Sharma D, Thiyagarajan B. Effect of losartan compared with captopril on mortality in patients with symptomatic heart failure: randomised trial--the Losartan Heart Failure Survival Study ELITE II. Lancet 2000 May 6;355(9215):1582-7. [PubMed]

Primary/Secondary Keywords