Is Losartan effective for treating heart failure?

From the Guidelines

Losartan is effective for treating heart failure, particularly when used at a high dose of 150 mg daily.

Key Evidence

• The HEAAL trial 1 showed that 150 mg daily of losartan was superior to 50 mg daily, with a 10% relative risk reduction in death or heart failure hospitalization.
• The ELITE II trial 1 failed to show that losartan 50 mg daily was as effective as captopril 50 mg three times daily, highlighting the importance of using a high enough dose.
• The OPTIMAAL trial 1 also demonstrated that losartan 50 mg once daily did not demonstrate non-inferiority when compared with captopril, further supporting the need for a higher dose.

Dosage and Administration

• The 2020 ACC/AHA clinical performance and quality measures for adults with heart failure 1 recommend a target dose of losartan of 150 mg once daily, although the FDA-approved labeling has 100 mg as the maximal dose.
• The 2012 ESC guidelines 1 suggest that losartan can be used as an alternative to ACE inhibitors in patients with heart failure, particularly those who are intolerant to ACE inhibitors.

Clinical Considerations

• ARBs, including losartan, have been shown to reduce the risk of heart failure hospitalization and improve symptoms and quality of life 1.
• The use of high doses of renin-angiotensin system blockers, such as losartan, is important to achieve optimal benefits 1.
• Physicians should aim to titrate patients to the target dose of losartan, rather than maintaining them on a low starting dose 1.

From the Research

Efficacy of Losartan in Treating Heart Failure

• Losartan has been shown to be effective in treating heart failure, with studies demonstrating its ability to reduce mortality and morbidity in patients with heart failure 2, 3, 4.
• The Losartan Heart Failure Survival Study--ELITE II found that losartan was comparable to captopril in reducing overall deaths and sudden cardiac death and/or resuscitated cardiac arrest in patients with heart failure 2.
• The HEAAL study found that high-dose losartan (150 mg daily) reduced the rate of death or admission for heart failure in patients with heart failure, compared to low-dose losartan (50 mg daily) 3.
• A review of existing data on losartan found that it has a similar safety profile to placebo and comparable efficacy to ACE inhibitors in reducing morbidity and mortality in patients with heart failure 4.

Comparison to Other Treatments

• Losartan has been compared to other treatments, including captopril and enalapril, and has been found to be of comparable efficacy and tolerability 2, 5, 6.
• A study comparing losartan to enalapril found that both treatments had similar effects on clinical status and exercise performance in patients with moderate or severe chronic heart failure 6.
• Losartan has also been found to be better tolerated than some other treatments, including captopril and atenolol, in certain patient populations 5.

Patient Populations

• Losartan has been studied in various patient populations, including elderly patients and those with hypertension, renal disease, or heart failure 2, 3, 4, 5.
• The ELITE II study found that losartan was effective in reducing mortality and morbidity in elderly patients with heart failure 2.
• Losartan has also been found to be effective in patients with hypertension, including those with isolated systolic hypertension 5.