From the Guidelines
The equivalent dose of lisinopril 40mg is approximately valsartan 320mg. When switching from an ACE inhibitor like lisinopril to an ARB like valsartan, this dose conversion provides similar blood pressure lowering effects, as seen in the dose comparison tables 1. The transition should be monitored closely as individual responses may vary.
Key Considerations
- While both medications work on the renin-angiotensin-aldosterone system, they do so through different mechanisms - lisinopril prevents the formation of angiotensin II by inhibiting ACE, while valsartan blocks the angiotensin II receptor directly.
- This difference explains why some patients who experience cough with lisinopril may tolerate valsartan better.
- When making this switch, blood pressure should be checked within 1-2 weeks to ensure adequate control, and dosage adjustments may be necessary based on the patient's response.
- Kidney function and potassium levels should also be monitored, particularly in patients with renal impairment or those taking potassium supplements or potassium-sparing diuretics, as both ACE inhibitors and ARBs can affect these parameters 1.
Monitoring and Adjustments
- Regular follow-up is crucial to assess the effectiveness of the dose conversion and to make any necessary adjustments to achieve optimal blood pressure control.
- The goal is to maintain blood pressure at or below 130/80 mm Hg, especially in patients with diabetes or chronic kidney disease, as higher levels of blood pressure are associated with more rapid progression of kidney disease 1.
From the Research
Equivalent Dose of Lisinopril to Valsartan
To determine the equivalent dose of lisinopril 40mg to valsartan, we need to examine the available evidence from clinical trials.
- The study 2 compared valsartan 160mg with lisinopril 20mg, but it does not provide a direct comparison with lisinopril 40mg.
- Another study 3 compared valsartan 80mg (titrated to 160mg) with lisinopril 10mg (titrated to 20mg), which also does not provide a direct comparison with lisinopril 40mg.
- However, the study 4 compared the efficacy and safety of combination therapy of valsartan and lisinopril with valsartan and lisinopril high-dose monotherapy, including lisinopril 40mg.
- In this study 4, the dose of valsartan used was 320mg, which can be considered as a high dose.
- The study 5 provides information on equivalent doses, stating that sacubitril/valsartan 97/103 is equivalent to valsartan 160mg twice daily, which is equivalent to enalapril 20mg twice daily or ramipril 5mg twice daily.
- However, the dose of lisinopril used in this study 5 is not directly comparable to the dose of 40mg.
- The study 6 compared valsartan 40mg (titrated to 80mg) with lisinopril 2.5mg (titrated to higher doses), but it does not provide a direct comparison with lisinopril 40mg.
Key Findings
- Based on the available evidence, it is challenging to determine the exact equivalent dose of lisinopril 40mg to valsartan.
- However, the study 4 suggests that valsartan 320mg may be considered as a high dose, and the study 5 provides information on equivalent doses of different angiotensin receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors (ACEIs).
- Further research is needed to determine the equivalent dose of lisinopril 40mg to valsartan.
Dose Comparison
- The available evidence does not provide a clear dose comparison between lisinopril 40mg and valsartan.
- However, based on the study 4, it can be estimated that valsartan 320mg may be equivalent to lisinopril 40mg, but this is not a direct comparison and should be interpreted with caution.
- The study 5 provides information on equivalent doses, but it is not directly applicable to the comparison between lisinopril 40mg and valsartan.