From the Guidelines
The recommended starting dose of lisinopril for treating hypertension is typically 10 mg once daily, which can be adjusted based on blood pressure response, as stated in the 2007 American Journal of Kidney Diseases guideline 1. For most adults, the usual maintenance dose ranges from 20 to 40 mg once daily. Lisinopril should be taken at approximately the same time each day to maintain consistent blood levels. It works by inhibiting angiotensin-converting enzyme (ACE), which prevents the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor. This leads to decreased peripheral resistance, reduced sodium and water retention, and ultimately lower blood pressure. Blood pressure should be monitored regularly after starting lisinopril, and dose adjustments should typically be made at 2-4 week intervals to allow the full effect of each dose to be assessed. Common side effects include dry cough, dizziness, and headache, and patients should be aware that ACE inhibitors can cause angioedema in rare cases, which requires immediate medical attention. The 2017 American College of Cardiology/American Heart Association hypertension guideline also supports the use of lisinopril as a first-line treatment for hypertension, with a recommended blood pressure target of less than 130/80 mm Hg 1. Key considerations in managing hypertension with lisinopril include:
- Monitoring blood pressure regularly
- Adjusting the dose as needed to achieve the target blood pressure
- Being aware of potential side effects, such as dry cough and dizziness
- Considering the use of other antihypertensive agents if blood pressure remains uncontrolled on lisinopril alone. Overall, lisinopril is a effective and well-tolerated treatment for hypertension, and can be used as part of a comprehensive treatment plan to reduce the risk of cardiovascular disease.
From the FDA Drug Label
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. The recommended starting dose in adult patients with hypertension taking diuretics is 5 mg once per day.
The recommended dose of lisinopril for treating hypertension is:
- Initial dose: 10 mg once a day
- Usual dosage range: 20 mg to 40 mg per day
- Starting dose with diuretics: 5 mg once per day 2
From the Research
Lisinopril Dose for Hypertension
The recommended dose of lisinopril for treating hypertension varies depending on the patient's renal function and blood pressure response.
- The starting dose is typically 2.5 mg in patients with a glomerular filtration rate (GFR) of less than 30 ml/min, and 5 mg in all other patients 3, 4, 5.
- The dose can be titrated upward to a maximum of 40 mg daily according to blood pressure response 3, 4, 5.
- In some cases, a diuretic may be added if blood pressure is not controlled 3, 4, 5.
Median Dose of Lisinopril
- The median dose of lisinopril used in studies was 10 mg (range 2.5-40 mg) 3, 4, 5.
- In elderly patients, the median dose was 20 mg daily (range 5-40 mg daily) 6.
Renal Function and Lisinopril Dose
- Lisinopril is excreted unchanged by the kidney, and reduced renal function may affect the drug's antihypertensive efficacy and safety 3, 4, 5.
- The mean glomerular filtration rate (GFR) was unchanged during the study in patients with impaired renal function 3, 4, 5.