From the Guidelines
Losartan and nifedipine can be used together to treat hypertension, as this combination is considered effective and well-tolerated, according to the 2007 guidelines for the management of arterial hypertension 1. This combination therapy is often prescribed when a single medication doesn't adequately control blood pressure. Losartan is an angiotensin II receptor blocker (ARB) that works by relaxing blood vessels through blocking the action of angiotensin II, while nifedipine is a calcium channel blocker that prevents calcium from entering the cells of the heart and blood vessels, causing them to relax. These medications work through different mechanisms, making them complementary when used together. Typical dosing might include losartan 50-100 mg once daily and nifedipine extended-release 30-90 mg once daily, though dosages should be individualized based on blood pressure response and tolerance. Patients should be monitored for potential side effects such as dizziness, headache, swelling in the ankles or feet, and excessive blood pressure lowering. This combination may be particularly beneficial for patients with certain comorbidities like diabetes or kidney disease, where ARBs offer additional protective effects beyond blood pressure control, as noted in the 2015 treatment of hypertension in patients with coronary artery disease guidelines 1. It's also worth noting that the 2013 ESH/ESC guidelines for the management of arterial hypertension support the use of combination therapy, including the combination of an ACE inhibitor and a calcium antagonist, or an angiotensin receptor blocker and a calcium antagonist 1. However, the most recent and highest quality study, which is the 2015 guidelines, should be prioritized when making a definitive recommendation, and it supports the use of losartan and nifedipine together to treat hypertension. Some key points to consider when using this combination include:
- Monitoring blood pressure regularly to adjust dosages as needed
- Watching for potential side effects and adjusting the treatment plan accordingly
- Considering the use of fixed-dose combinations to simplify treatment and improve patient compliance
- Tailoring the treatment plan to the individual patient's needs, taking into account comorbidities and other factors that may influence the choice of therapy.
From the Research
Combination Therapy of Losartan and Nifedipine
- The combination of losartan and nifedipine can be used to treat hypertension, as evidenced by a study published in the Journal of cardiovascular pharmacology 2.
- This study found that the combination of low-dose nifedipine GITS 20 mg and losartan 50 mg was effective in lowering elevated blood pressure in patients with mild to moderate hypertension.
- The combination therapy was found to be safe and well-tolerated, with no significant changes in heart rate or adverse events.
Efficacy of Combination Therapy
- Another study published in the Journal of cardiovascular pharmacology found that the combination of losartan and nifedipine had beneficial effects on hypertensive Dahl salt-sensitive rats 3.
- The study found that the combination therapy reduced systolic blood pressure, aorta and left ventricular hypertrophy, and improved renal function.
- The combination therapy also reduced the expression of transforming growth factor-beta1 in aorta and brain natriuretic peptide in left ventricle.
Comparison with Other Treatments
- A study published in the Journal of human hypertension compared the efficacy and tolerability of losartan alone or with hydrochlorothiazide versus nifedipine GITS in elderly patients with diastolic hypertension 4.
- The study found that the losartan regimen had similar efficacy to the nifedipine GITS regimen, but with greater tolerability and less symptom bother due to swollen ankles.
- Another study published in Clinical pharmacology in drug development found that the pharmacokinetic profiles of a fixed-dose combination of amlodipine, losartan, and chlorthalidone were equivalent to those of individual tablets in a loose combination 5.