Losartan Does Not Lower Heart Rate
Losartan, as an angiotensin II receptor blocker (ARB), does not reduce pulse or heart rate—this is not a mechanism of action for this drug class. If you need heart rate control in a hypertensive patient with tachycardia, you must add a different medication class.
Why Losartan Doesn't Affect Heart Rate
ARBs work by blocking angiotensin II receptors, which lowers blood pressure through vasodilation and reduced aldosterone secretion, but they have no direct effect on heart rate. 1
Clinical trial data from the LIFE study specifically documented that losartan treatment had no significant changes in 24-hour heart rate despite effective blood pressure reduction. 2
In the CRONOS study evaluating losartan's antihypertensive effects over 24 hours, researchers found that while blood pressure decreased significantly, "there were no significant changes in 24h heart rate." 2
A study examining losartan's effects on arrhythmias in hypertensive men confirmed that while losartan effectively controlled blood pressure and reduced left ventricular hypertrophy, it did not alter cardiac rhythm or rate. 3
What Losartan Actually Does
Losartan effectively lowers blood pressure (reductions of approximately 26/20 mmHg documented) and provides cardiovascular protection through blood pressure reduction and cardiac remodeling effects. 4
The drug reduces left ventricular mass by 21.7 g/m² in hypertensive patients with left ventricular hypertrophy, superior to beta-blockers like atenolol (17.7 g/m²). 1
In the LIFE trial, losartan reduced cardiovascular events by 13% and stroke by 25% compared to atenolol in patients with left ventricular hypertrophy, despite similar blood pressure reductions. 5
If You Need Heart Rate Control
Beta-blockers are recommended when heart rate control is needed in addition to blood pressure management, particularly in patients with angina, post-myocardial infarction, heart failure with reduced ejection fraction, or atrial fibrillation requiring rate control. 1
Current guidelines recommend combining beta-blockers with other major blood pressure-lowering drug classes (including ARBs like losartan) when there are compelling indications for heart rate control. 1
In the LIFE study comparing losartan to the beta-blocker atenolol, only atenolol reduced heart rate—this was a distinguishing feature between the two drugs despite similar blood pressure effects. 1
Clinical Bottom Line
If your patient has both hypertension and tachycardia requiring treatment, losartan alone will not address the elevated heart rate. You need to add a beta-blocker or consider a non-dihydropyridine calcium channel blocker (diltiazem or verapamil) if beta-blockers are contraindicated. 1 The combination of an ARB with a beta-blocker is explicitly recommended in current guidelines when both blood pressure and heart rate control are therapeutic goals. 1