Switching From Losartan To Candesartan Achieves Significant Reductions In Blood Pressure Over 2 Years

Main Category: Hypertension
Article Date: 07 Mar 2008 - 1:00 PDT

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Changing from losartan to candesartan achieves significant reductions in blood pressure over a two-year period according to a study in the January issue of IJCP, the International Journal of Clinical Practice.1 In addition, the cost of candesartan is 21-23% lower than losartan, therefore offering significantly greater cost effectiveness.

Of 94 patients still registered at a Primary Care Practice and taking an angiotensin-receptor blocker (ARB) 2 years after a switch from losartan to candesartan, 98% were still taking candesartan. Systolic and diastolic blood pressures were 7.0 and 2.0 mmHg lower respectively 2 years after the change. This was statistically significant (P<<0.05).

The study was carried out at a Hertfordshire Primary Care Practice, which had been asked by the local Primary Care Trust to switch suitable patients from atorvastatin to simvastatin and losartan to candesartan for cost saving purposes. Clinic blood pressure readings, together with records of cardiovascular events occurring during the 2-year period, were used to assess the overall impact of switching patients from losartan to candesartan on both an individual and practice level. All patients currently prescribed losartan were identified from computer records and screened for switching suitability. Those identified as suitable were informed of the proposed change to their medication and asked to contact their GP with any concerns. Patients were switched to doses of candesartan approximately equivalent to their current doses of losartan (4 mg candesartan for each 25 mg losartan).

108 patients were switched from losartan to candesartan. After 2 years, 100 patients were still registered at the practice, 94 of whom were taking an ARB and 92 of these (98%) were still on candesartan. There was a statistically significant reduction in blood pressure 2 years after the switch (138.0/79.0 ± 12.9/6.6 to 131.0/77.0 ± 13.1/7.6 mmHg; P<<0.05).

"Switching from losartan to candesartan in a systematic manner with a careful follow up was not only cost effective but achieved a significant fall in blood pressure providing effective prescribing and improved patient care," commented Professor Mike Kirby, University of Hertfordshire, who led the research team. He also noted that "this was a small observational study and some of the effect on blood pressure may have been due to organisational factors and increased vigilance."

The switch from losartan to candesartan was not associated with any adverse events. Of the 108 patients switched, six transferred out of the practice and two died, one from cardiovascular disease. Among the remaining 100 patients originally switched and still registered at the practice, the only cardiovascular event reported was a non-ST elevation myocardial infarction in an 83-year old patient with known unstable angina and a previous MI.

References

1) Evaluation of the clinical outcomes of switching patients from atorvastatin to simvastatin and losartan to candesartan in a primary care setting: 2 years on.
International Journal of Clinical Practice Jan 2008 (1-5).

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