High-dose versus low-dose losartan in patients with heart failure

摘要

The HEAAL investigators (Nov 28, p 1840) show that high-dose losartan, compared with low-dose losartan, can reduce mortality and readmis-sion to hospital in patients with heart failure. The dose-dependent side-effects of losartan such as renal impairment, hypotension, and hyperkalaemia were more common in the high-dose group. Hyper-uricaemia has been shown to be a strong, independent marker of poor prognosis in patients with congestive heart failure. Losartan can decrease uric acid concentrations, whereas other angiotensin-receptor blockers cannot. The uricosuric effect of losartan may be related to the mechanisms of clinical benefit, so it would be interesting to know whether there were any dosedependent uricosuric effects of losartan in the HEAAL study.