Comparison of the efficacy of candesartan and losartan: a meta-analysis of trials in the treatment of hypertension

Abstract

Informed by the findings from prospective observational studies and randomized outcome trials, guidelines for the management of hypertension acknowledge that the benefit of treatment can be attributed largely to blood pressure (BP) reduction. Therefore, quantification of differential BP lowering of different agents within classes of anti-hypertensives is of practical importance. The objective of this analysis was to compare the efficacy of candesartan and losartan with respect to reduction in systolic and diastolic BP (SBP and DBP). A systematic literature search of databases from 1980 to 1 October 2008 identified 13 studies in which candesartan and losartan were compared in randomized trials in hypertensive patients. Data from 4066 patients were included in the analysis using a random effect model. Mean changes in SBP and DBP were compared for each drug alone and after stratification for dose and for combination with hydrochlorothiazide (HCTZ). On the basis of all the data, the weighted mean difference favoured candesartan-3.22 mm Hg (95% confidence interval (CI) 2.16, 4.29) for SBP and 2.21 mm Hg (95% CI 1.34, 3.07) for DBP. These findings were consistent when analyses according to dose and combination with HCTZ were carried out. Thus, it can be concluded that at currently recommended doses, candesartan is more effective than losartan in lowering BP.

Comments on systematic review of clinical- and cost-effectiveness of candesartan and losartan in hypertension and heart failure

“…(1) and the associated commentaries (2,3). We are reassured that the author’s meta‐analysis is entirely consistent with a more wide ranging and comparable analysis published over a year ago (4). However, certain aspects of the analyses and the interpretation give us cause for concern.…”

“…The potential clinical importance of a 1.96 mmHg difference in diastolic blood pressure (DBP) is based upon cost‐utility analysis utilising a 10‐year Markov model. This ignores epidemiological evidence and findings from outcome trials (4) and fails to acknowledge the 2006 Health Survey for England which suggests that a reduction in 2 mmHg of DBP would save 14,000 lives per annum in the UK (5). Although there are no outcome trials comparing different ARBs, there is no acknowledgement of a study that utilised data from electronic primary care journals and mandatory Swedish national registers for death and hospitalisation, which suggested that, in the treatment of hypertension, there is a BP independent risk reduction in cardiovascular disease with candesartan compared with losartan (6).…”

Getting better value from the NHS drug budget

“…• A Cochrane review concluded all drugs in the group have a statistically equivalent effect on blood pressure 10 • Small differences in blood pressure lowering effect are likely to be unimportant in clinical practice, where blood pressure is treated to target with diet and exercise as well as drugs [11][12][13] • Losartan costs 43p per month per mm Hg systolic blood pressure reduction (figure⇓)…”

Examining the Association of Olmesartan and Other Angiotensin Receptor Blockers With Overall and Cause-Specific Mortality

“…For example, candesartan has a stronger affinity for the receptor and is more effective at lowing BP than losartan. 14,15 This observation may explain the Swedish Heart Failure Registry finding a lower mortality risk associated with candesartan compared with losartan. 16 In this same regard, other studies demonstrated a greater reduction in BP in those treated with olmesartan compared with losartan and valsartan.…”

“…18,19 Previous studies showed that candesartan, telmisartan, irbesartan, and olmesartan are superior to losartan in reducing BP. 15,[20][21][22][23][24] The superior antihypertensive effects might explain the slight reduction in the overall mortality of those 4 above-mentioned ARBs. These observations add circumstantial support to the hypothesis that differences in antihypertensive efficacy may account for the differences in mortality risk.…”