What is the comparison between Candesartan (Angiotensin II receptor antagonist) and Losartan (Angiotensin II receptor antagonist)?

From the Guidelines

Candesartan is generally preferred over losartan due to its higher potency and longer duration of action, as well as its proven benefits in reducing the risk of heart failure hospitalization and cardiovascular death, as demonstrated in the CHARM-Added trial 1.

Comparison of Candesartan and Losartan

• Both candesartan and losartan are angiotensin II receptor blockers (ARBs) used to treat hypertension and heart failure.
• Candesartan is typically started at 8-16 mg once daily (maximum 32 mg daily), while losartan usually begins at 50 mg once daily (maximum 100 mg daily) 1.
• Candesartan provides more consistent 24-hour blood pressure control due to its longer half-life and tighter binding to the angiotensin receptor.
• The CHARM-Added trial showed that candesartan reduced the risk of heart failure hospitalization by 17% and cardiovascular death by 16% 1.
• In contrast, the ELITE II trial failed to show that losartan 50 mg daily was as effective as captopril 50 mg three times daily, although the HEAAL trial showed that 150 mg daily of losartan was superior to 50 mg daily 1.
• The choice between candesartan and losartan often depends on individual patient factors such as comorbidities, cost considerations, and dosing preference.
• Both medications are generally well-tolerated with similar side effect profiles, including dizziness, headache, and hyperkalemia.
• The 2020 ACC/AHA clinical performance and quality measures for adults with heart failure recommend target doses of 32 mg daily for candesartan and 100 mg daily for losartan 1.
• The higher potency and longer duration of action of candesartan make it a preferred choice for patients with heart failure, although losartan may be considered for patients with hyperuricemia or gout due to its unique uricosuric effect.
• Patients should be monitored for blood pressure response, kidney function, and potassium levels while taking either medication.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Comparison of Candesartan and Losartan

• Candesartan cilexetil is an angiotensin II type 1 (AT1) receptor antagonist that inhibits the actions of angiotensin II on the renin-angiotensin-aldosterone system 2.
• Clinical trials have demonstrated that candesartan cilexetil is an effective agent in reducing the risk of cardiovascular mortality, stroke, heart failure, arterial stiffness, renal failure, retinopathy, and migraine in different populations of adult patients, including patients with coexisting type 2 diabetes, metabolic syndrome, or kidney impairment 2.
• Candesartan cilexetil provides better antihypertensive efficacy than losartan and is at least as effective as telmisartan and valsartan 2.
• A study comparing the antihypertensive effect and tolerability of candesartan cilexetil with losartan found that candesartan cilexetil, 16 mg once daily, produces a significantly greater reduction in blood pressure than losartan, 50 mg once daily 3.
• The trough-to-peak ratio of candesartan cilexetil is approximately 1.0, compared with 0.7 for losartan, indicating a longer duration of action for candesartan cilexetil 3.
• Candesartan cilexetil, 8 to 16 mg/day, was found to be at least as effective as therapeutic dosages of losartan or other angiotensin II receptor antagonists in randomized studies 4.
• At a dosage of up to 32 mg/day, candesartan cilexetil demonstrated greater antihypertensive efficacy than losartan 50 or 100 mg/day 4.

Efficacy and Safety

• Candesartan cilexetil is well tolerated and is not associated with cough, a common adverse effect of angiotensin converting enzyme inhibitor treatment 4.
• A pooled analysis of clinical trials found that the tolerability profile of candesartan cilexetil is not significantly different from that of placebo 4.
• Adverse events are not dose-related and are generally of mild to moderate severity 4.
• Losartan/hydrochlorothiazide combination therapy was found to be effective in reducing blood pressure, with similar efficacy to candesartan/amlodipine combination therapy 5.
• Candesartan has been shown to be of clinical value in a broad spectrum of patients with symptomatic heart failure, regardless of background therapy and ventricular function 6.