What medication is effective for lowering diastolic blood pressure?

From the Guidelines

ACE inhibitors like lisinopril or ARBs like losartan are the most effective choices for lowering diastolic blood pressure, as evidenced by the latest guidelines from the European Heart Journal in 2024 1. These medications work by relaxing blood vessels, which directly reduces diastolic pressure. They also have additional benefits like protecting the kidneys and reducing cardiovascular risk. The 2024 ESC guidelines for the management of elevated blood pressure and hypertension suggest that the magnitude of BP reduction achieved with ACE inhibitors, ARBs, and other main classes of BP-lowering medications is similar overall, with an expected reduction of approximately 9/5 mmHg with office BP and 5/3 mmHg with ABPM 1. Some key points to consider when using these medications include:

• Starting with a low dose, such as lisinopril 10mg or losartan 50mg once daily, and titrating up as needed under medical supervision
• Combining medication with lifestyle changes, such as:
  • Reducing sodium intake to less than 2,300mg per day
  • Exercising regularly (30 minutes of moderate activity most days)
  • Maintaining a healthy weight
  • Limiting alcohol consumption
• Monitoring blood pressure at home and following up with a doctor regularly to adjust treatment as needed
• Being aware that these medications may cause dizziness or a dry cough in some people, and consulting a healthcare provider about alternatives if side effects occur. It's also important to note that the BP-lowering effect of each medication can vary at the individual level, and may require personalization by matching the patient with the best medication for them, as suggested by the 2024 ESC guidelines 1.

From the FDA Drug Label

Lisinopril demonstrated superior reductions of systolic and diastolic compared to hydrochlorothiazide in a population that was 75% Caucasian Lisinopril was approximately equivalent to atenolol and metoprolol in reducing diastolic blood pressure, and had somewhat greater effects on systolic blood pressure. The dose-dependent antihypertensive effect of lisinopril was consistent across several demographic subgroups: age, Tanner stage, gender, and race In this study, lisinopril was given either as tablets or in a suspension for those children and infants who were unable to swallow tablets or who required a lower dose than is available in tablet form

Lisinopril is effective for lowering diastolic blood pressure 2.

• It has been shown to be effective in various demographic subgroups.
• The medication has a dose-dependent antihypertensive effect.
• Lisinopril is approximately equivalent to atenolol and metoprolol in reducing diastolic blood pressure.

From the Research

Effective Medication for Lowering Diastolic Blood Pressure

• Lisinopril is an effective medication for lowering diastolic blood pressure, as it inhibits angiotensin-converting enzyme (ACE) activity, reducing plasma angiotensin II and aldosterone, and increasing plasma renin activity 3.
• Studies have shown that lisinopril produces a smooth, gradual blood pressure reduction in hypertensive patients without affecting heart rate or cardiovascular reflexes, with the antihypertensive effect beginning within 2 hours, peaking around 6 hours, and lasting for at least 24 hours 3.
• Lisinopril has been compared to other medications, such as hydrochlorothiazide (HCTZ), atenolol, metoprolol, and nifedipine, and has been found to be at least as effective in reducing diastolic blood pressure 3, 4.
• The combination of lisinopril with other medications, such as amlodipine, has been shown to have a significant additional blood pressure lowering effect compared to monotherapy 5.
• Lisinopril has been found to be effective in lowering blood pressure in various patient populations, including elderly patients, with response rates ranging from 68.2 to 89.1% 6.

Dosage and Administration

• Lisinopril can be administered once daily, with dosages ranging from 2.5 to 40 mg/day, depending on the patient's condition and response to treatment 3, 6.
• In patients with significant renal impairment, lower dosages of lisinopril may be necessary 6.
• The combination of lisinopril with other medications, such as HCTZ, can enhance its antihypertensive effect 3, 5.

Safety and Tolerability

• Lisinopril has been found to be well tolerated, with a good safety profile, and few serious adverse effects reported 3, 4, 6.
• The most common adverse effects of lisinopril are similar to those of other ACE inhibitors, and include cough, dizziness, and headache 6.
• Lisinopril has been found to have a low incidence of discontinuation due to adverse events, although elderly patients may be more likely to discontinue treatment 6.