From the Guidelines
Lisinopril is recommended as an effective treatment for both hypertension and heart failure, typically starting at 10mg once daily for hypertension and 2.5-5mg daily for heart failure, with gradual titration based on patient response. For hypertension, the dose can be increased to 20-40mg daily, while heart failure patients may require up to 20-40mg daily to achieve optimal benefits. Treatment should be initiated at lower doses (2.5-5mg) in elderly patients, those with renal impairment, or patients on diuretics. Patients should take lisinopril at the same time each day, with or without food, and continue the medication even when feeling well. Common side effects include dry cough, dizziness, and headache. Blood pressure, renal function, and potassium levels should be monitored regularly, especially during dose adjustments. ACE inhibitors like lisinopril work by blocking the conversion of angiotensin I to angiotensin II, reducing vasoconstriction and aldosterone secretion, which lowers blood pressure and decreases cardiac workload. This mechanism provides both symptomatic relief and long-term cardiovascular protection, including reduced mortality in heart failure patients and decreased risk of cardiovascular events in hypertensive patients, as supported by studies such as 1.
Some key points to consider when using lisinopril include:
- Starting with a low dose and titrating upwards to minimize side effects and maximize efficacy
- Monitoring renal function and potassium levels regularly, especially in patients with pre-existing kidney disease or those taking other medications that affect kidney function
- Being aware of potential interactions with other medications, such as diuretics, and adjusting the dose of lisinopril accordingly
- Educating patients on the importance of adherence to their medication regimen and regular follow-up appointments to monitor their condition and adjust treatment as needed.
Overall, lisinopril is a well-established and effective treatment for hypertension and heart failure, and its use is supported by a strong evidence base, including guidelines from reputable organizations such as the American College of Cardiology Foundation and the American Heart Association 1.
From the FDA Drug Label
DOSAGE & ADMINISTRATION 2. 1 Hypertension Initial Therapy in adults: The recommended initial dose is 10 mg once a day. Dosage should be adjusted according to blood pressure response. The usual dosage range is 20 mg to 40 mg per day administered in a single daily dose. 2. 2 Heart Failure The recommended starting dose for lisinopril tablets, when used with diuretics and (usually) digitalis as adjunctive therapy for systolic heart failure, is 5 mg once daily. INDICATIONS & USAGE 1. 1 Hypertension Lisinopril tablets USP are indicated for the treatment of hypertension in adult patients and pediatric patients 6 years of age and older to lower blood pressure. 1.2 Heart Failure Lisinopril tablets USP are indicated to reduce signs and symptoms of systolic heart failure.
The recommended treatment and management for patients with hypertension or heart failure using Lisinopril is as follows:
- For hypertension:
- Initial dose is 10 mg once a day for adults
- Dosage should be adjusted according to blood pressure response
- Usual dosage range is 20 mg to 40 mg per day administered in a single daily dose
- For heart failure:
- Recommended starting dose is 5 mg once daily when used with diuretics and digitalis as adjunctive therapy for systolic heart failure
- Increase as tolerated to a maximum of 40 mg once daily
- Diuretic dose may need to be adjusted to help minimize hypovolemia, which may contribute to hypotension 2 Lisinopril may be administered alone or with other antihypertensive agents 2.
From the Research
Treatment and Management of Hypertension and Heart Failure with Lisinopril
Lisinopril, an Angiotensin-Converting Enzyme (ACE) inhibitor, is used to treat hypertension and heart failure. The recommended treatment and management for patients with these conditions using Lisinopril are as follows:
- Lisinopril is effective in lowering blood pressure in all grades of essential hypertension at dosages of 20 to 80 mg once daily 3.
- It is at least as effective as other antihypertensive agents, such as hydrochlorothiazide, atenolol, metoprolol, and nifedipine 3.
- In patients with congestive heart failure, Lisinopril improves indices of cardiac function and appears to produce greater benefit than captopril in one controlled study 3.
Comparison with Other ACE Inhibitors and Angiotensin II Receptor Antagonists
- ACE inhibitors, including Lisinopril, reduce mortality in patients with heart failure and are considered first-line options 4.
- Angiotensin II receptor antagonists (ARBs) have similar hemodynamic effects to ACE inhibitors but differ in their mechanism of action and certain adverse effects 4, 5, 6.
- ARBs may offer more complete inhibition of angiotensin II than ACE inhibitors and are considered an alternative for patients who cannot tolerate ACE inhibitors 5, 6.
- However, some studies suggest that ACE inhibitors remain the drugs of choice for patients with heart failure, left ventricular dysfunction after myocardial infarction, and diabetic nephropathy, while ARBs offer an alternative when ACE inhibitor therapy is not tolerated 6, 7.
Adverse Effects and Tolerability
- Lisinopril is well tolerated, with few serious adverse effects being reported 3.
- ACE inhibitors, including Lisinopril, are associated with cough and a low risk of angioedema and fatalities 4, 6, 7.
- ARBs have a lower risk of adverse events, such as cough and angioedema, compared to ACE inhibitors 4, 6, 7.
- Overall withdrawal rates due to adverse events are lower with ARBs than with ACE inhibitors 7.