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Randomised controlled trial
Compared with low-dose losartan, high-dose losartan decreases risk of death or hospital admission for heart failure in people with heart failure who are intolerant to ACE inhibitors
  1. Robert McKelvie
  1. Correspondence to Robert McKelvie
    David Braley Cardiac, Vascular and Stroke Research Institute, McMaster University and Hamilton Health Sciences, Hamilton General Hospital Campus, 237 Barton Street E, Hamilton, Ontario L8L 2X2, Canada; robert.mckelvie{at}

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This study by Konstam and colleagues in some ways expands on the findings of the Evaluation of Losartan in the Elderly II (ELITE II) study,1 which compared the effects of losartan 50 mg/day and captopril 150 mg/day. The ELITE II study found that the angiotensin receptor blocker (ARB) losartan was not superior to captopril, and the study design meant that it could not be concluded that losartan was non-inferior to captopril.1 After publication of ELITE II there was speculation that the lack of benefit observed was due to the dose of losartan being too low, because losartan 100 mg/day was found to be effective in improving clinical outcome in the Losartan Intervention for Endpoint Reduction in Hypertension (LIFE)2 and Reduction of Endpoints in NIDDM with the Angiotensin II Antagonist Losartan (RENAAL)3 studies. Thus the Heart failure Endpoint evaluation of Angiotensin II Antagonist Losartan (HEAAL) study was designed to examine whether losartan 150 mg/day would be more effective than losartan 50 …

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  • Competing interests RM has received grant support and an honorarium from Bristol-Myers Squibb and Sanofi-Aventis.