The ELITE II study randomised 3152 patients with NYHA class II - IV heart failure and ejection fraction of 40% or less to receive either losartan titrated to 50 mg once daily or captopril titrated to 50 mg three times daily. The median follow-up time was 555 days. There were no significant differences in all-cause mortality (11.7 bs 10.4% average annual mortality rate) or sudden death or resuscitation arrests (9.0% vs 7.3%) between the two treatment groups. Significantly fewer patients in the losartan group (excluding those who died) discontinued study treatment because of adverse effects (9.7 vs 14.7%, p<0.001) including cough (0.3 vs 2.7%).
Comment: The quality of evidence is downgraded by inconsistency (variability in results across studies; the superiority of losartan suggested by ELITE I study based on secondary analysis was not supported in this trial).