====== Losartan ======

Losartan, sold under the brand name Cozaar among others, is a medication used to treat [[arterial hypertension]].

It is in the [[angiotensin receptor blocker]] (ARB) family of [[medication]] and is considered protective of the kidneys. 

Besides hypertension, it is also used in diabetic kidney disease, heart failure, and left ventricular enlargement.

It comes as a tablet that is taken by mouth.

It may be used alone or in addition to other blood pressure medication.

Up to six weeks may be required for the full effects to occur.

===== In neurosurgery =====
{{rss>https://pubmed.ncbi.nlm.nih.gov/rss/search/1N7QVXLjMpInSW4GPEevJMeNFYLOQi2RbHzh0cvbtptphmEMqP/?limit=15&utm_campaign=pubmed-2&fc=20240119132905}}
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It was reported in a retrospective series that [[angiotensin receptor blocker]]s might be associated with reduced [[peritumoral edema]]. The ASTER study is a randomized, placebo-controlled trial to assess whether or not the addition of [[Losartan]] to standard of care (SOC) can reduce [[steroid]] requirement during [[radiotherapy]] (RT) in patients with newly diagnosed [[Glioblastoma]].

Patients with a histologically confirmed Glioblastoma after [[biopsy]] or partial surgical [[resection]] were randomised between Losartan or placebo in addition to SOC with RT and [[temozolomide]] (TMZ). The primary objective was to investigate the steroid dosage required to control [[brain edema]] on the last day of RT in each arm. The secondary [[outcome]]s were steroids dosage 1 month after the end of RT, assessment of cerebral oedema on [[magnetic resonance imaging]], tolerance and survival.

Seventy-five patients were randomly assigned to receive Losartan (37 patients) or [[placebo]] (38 patients). No difference in the steroid dosage required to control [[brain edema]] on the last day of RT, or one month after completion of RT, was seen between both arms. The [[incidence]] of [[adverse event]]s was similar in both arms. Median [[overall survival]] was similar in both arms.

Losartan, although well tolerated, does not reduce the steroid requirement in newly diagnosed Glioblastoma patients treated with concomitant RT and TMZ. Trial registration number NCT01805453 with ClinicalTrials.gov
((Ursu R, Thomas L, Psimaras D, Chinot O, Le Rhun E, Ricard D, Charissoux M,
Cuzzubbo S, Sejalon F, Quillien V, Hoang-Xuan K, Ducray F, Portal JJ, Tibi A,
Mandonnet E, Levy-Piedbois C, Vicaut E, Carpentier AF. Angiotensin II receptor
blockers, steroids and radiotherapy in glioblastoma-a randomised multicentre
trial (ASTER trial). An ANOCEF study. Eur J Cancer. 2019 Feb 1;109:129-136. doi: 
10.1016/j.ejca.2018.12.025. [Epub ahead of print] PubMed PMID: 30716716.
)).
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Blocks brain TGF-β signaling and prevents epilepsy in the albumin or blood-brain barrier breakdown models of epileptogenesis
((Welling LC, Rabelo NN, Gonçalves de Sena Barbosa M, Luciano LL, Figueiredo EG. Losartan and Traumatic Brain Injury: Why Is a Retrospective Study Urgent? World Neurosurg. 2021 Oct;154:167-168. doi: 10.1016/j.wneu.2021.07.095. PMID: 34583471.)).