From the Guidelines
For a patient with stage 1 hypertension and a blood pressure of 140/90, the recommended starting dose of lisinopril is 10 mg once daily, with the option to increase to 20-40 mg daily if needed, as supported by the most recent guidelines 1. The dose can be adjusted based on blood pressure response, and patients should be aware that the full effect may take several weeks to develop. Regular blood pressure monitoring is important during this time. Lisinopril works by inhibiting angiotensin-converting enzyme (ACE), which relaxes blood vessels and reduces blood pressure. Some key points to consider when prescribing lisinopril include:
- Common side effects include dry cough, dizziness, and headache
- It's essential to stay hydrated but avoid using potassium supplements or salt substitutes containing potassium without medical advice, as lisinopril can increase potassium levels
- Blood tests to check kidney function and potassium levels are typically recommended after starting therapy
- If side effects occur, particularly persistent cough or swelling of the face/lips, medical attention should be sought promptly The American College of Cardiology/American Heart Association guidelines recommend initiating therapy with thiazide diuretics, calcium-channel blockers, angiotensin-converting enzyme inhibitors, or angiotensin-receptor blockers for adults without a compelling indication for use of a specific drug 1. In the context of stage 1 hypertension, the goal is to achieve a blood pressure target of less than 130/80 mm Hg, and lisinopril is a suitable option for achieving this goal 1. Overall, the use of lisinopril for stage 1 hypertension is supported by recent guidelines and should be considered as part of a comprehensive treatment plan.
From the FDA Drug Label
DOSAGE & ADMINISTRATION 2. 1 Hypertension Initial Therapy in adults: The recommended initial dose is 10 mg once a day. The usual dosage range is 20 mg to 40 mg per day administered in a single daily dose.
For a blood pressure of 140/90, which is considered stage 1 hypertension, the recommended initial dose of lisinopril is 10 mg once a day. The dose may be adjusted according to blood pressure response, with a usual dosage range of 20 mg to 40 mg per day administered in a single daily dose 2.
From the Research
Lisinopril Dosage for Stage 1 Hypertension
The dosage of lisinopril for stage 1 hypertension, characterized by a blood pressure of 140/90, can vary based on several factors including renal function and the presence of other health conditions.
- The starting dose of lisinopril is typically 2.5 mg to 5 mg once daily, with titration upwards to achieve the desired blood pressure response 3, 4.
- For patients with stage 1 hypertension and normal renal function, a dose of 5 mg to 20 mg once daily may be effective in reducing blood pressure 5.
- In patients with impaired renal function, the starting dose should be lower, typically 2.5 mg once daily, and adjusted according to the patient's response and renal function 3, 4.
- The median dose of lisinopril used in clinical studies for hypertension has been around 10 mg daily, with some patients requiring doses up to 40 mg daily 3, 4.
Considerations for Dosage Adjustment
- Renal function is a critical factor in determining the dosage of lisinopril, as the drug is excreted unchanged by the kidneys 6, 3, 4.
- Patients with significant renal impairment may require lower doses and closer monitoring of renal function and blood pressure 3, 4.
- The addition of a diuretic may be necessary in some patients to achieve adequate blood pressure control 3, 4.