The role of losartan in the management of patients with heart failure

Background. Heart failure places a burden on patients and health care syste ms worldwide. Although the advent of angiotensin-converting enzyme (ACE) in hibitors markedly improved management of this chronic disorder, treatment i s still not optimal, and morbidity and mortality remain high. Objective: This review summarizes existing data on losartan, an angiotensin II (AII)receptor antagonist, and compares its potential role with that of ACE inhibitors in the management of patients with heart failure. Methods: Relevant primary studies and review articles were identified throu gh a MEDLINE search of the English-language literature for the past 5 years and through examination of the reference lists of the articles so identifi ed. Search terms included, but were not limited to, angiotensin-converting enzyme inhibitors, angiotensin II-receptor antagonists, and losartan. Results: Preclinical and clinical studies of losartan have demonstrated con sistent hemodynamic effects (via selective antagonism of the All type I rec eptor) and a safety profile similar to that of placebo (presumably a reflec tion of the selective approach to AII blockade). In addition, large-scale e nd-point studies have shown losartan to have comparable efficacy to ACE inh ibitors on a number of morbidity and mortality measures. Conclusions: There is strong evidence for the broad applicability of AII-an tagonists in heart failure and for the use of AII-antagonists in the treatm ent of a broader population of patients with heart failure, not only those who are unable to tolerate treatment with ACE inhibitors.