Prevention

• an angiotensin-II antagonist ^a

Why?

• Elderly patients on losartan compared with captopril are less likely to stop medication due to adverse effects or complain of a cough. ^a . However there is no clear difference in death or hospital admission. ^a
• Combining candersartan and enalapril does not clearly reduce death or hospital admission compared with either alone. ^d  

Losartan reduces death and hospital admissions

Patient	Treatment	Comparison	Outcome	CER	RRR (95% CI)	NNT (95% CI)
elderly with symptomatic heart failure and an ejection fraction ≥ 40% a	losartan	captopril	discontinued medication due to adverse effects at 1.5 years	15%	34% (20% to 45%)	20 (14 to 37)
			cough at 1.5 years	2.6%	88% (70% to 95%)	43 (31 to 66)