To the Editor: Dr Eklind-Cervenka and colleagues provided a retrospective analysis of the Swedish Heart Failure Registry showing a survival benefit of candesartan over losartan in patients with heart failure (HF) at 1 and 5 years.1 The association of lower mortality with candesartan was found both in patients with depressed (<40%) and preserved (≥40%) left ventricular ejection fraction. Although the authors offered various explanations for this benefit, they did not mention that losartan has never shown a benefit over any other angiotensin II–receptor blocker (ARB) or angiotensin-converting enzyme (ACE) inhibitor in HF patients.
The European Society of Cardiology (ESC) has never recommended the use of losartan for treating HF patients. In the 2002 guidelines for the diagnosis and treatment of chronic HF, the ESC did not mention losartan.2 In 2005, the ESC stated that only candesartan or valsartan should be used; losartan is mentioned as “also available” but not recommended.3 In 2008, only candesartan and valsartan were recommended.4 Furthermore, the American College of Cardiology/American Heart Association (ACC/AHA) guidelines in 2005 recommended losartan for prevention of HF in patients with hypertension or diabetic nephropathy,5 but no explicit recommendation for treating HF patients was given.
It is surprising then that in the analysis of the Swedish registry, nearly as many patients were treated with losartan (n = 2500) as with candesartan (n = 2639). In our view, this analysis highlights the importance of treating HF patients only with drugs that demonstrate a clear benefit over standard treatment and are consequently recommended by cardiovascular societies.
Conflict of Interest Disclosures: Both authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
Instructions
Comments are moderated and will appear on the site at the discretion of the Journal of American Medical Association editors. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest* Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more
Subscribe for full-text access to content from 1998 forward and a host of useful features
Activate your current subscription (AMA members and current subscribers)
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Customize your page view by dragging & repositioning the boxes below.
and access these and other features:
Register Now
Enter your username and email address. We'll send you a reminder to the email address on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.