From the Guidelines
Yes, an Angiotensin Receptor Blocker (ARB) can be used as initial antihypertensive therapy in a 55-year-old patient with hypertension and no other comorbidities instead of lisinopril. A good starting ARB would be losartan at a dose of 50 mg once daily, which can be increased to 100 mg daily if needed for better blood pressure control, as recommended by the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults 1. Other appropriate ARB options include valsartan (starting at 80-160 mg daily), olmesartan (20 mg daily), or irbesartan (150 mg daily) 1. ARBs work by blocking the binding of angiotensin II to its receptors, thereby reducing vasoconstriction and sodium retention. They provide similar efficacy to ACE inhibitors like lisinopril but typically have fewer side effects, particularly the dry cough that affects 5-20% of patients on ACE inhibitors. ARBs are generally well-tolerated, though patients should be monitored for hypotension, hyperkalemia, and changes in renal function. Blood pressure should be rechecked within 2-4 weeks of starting therapy to assess efficacy and adjust the dose if necessary. Lifestyle modifications including reduced sodium intake, regular exercise, and weight management should also be emphasized alongside medication therapy. It's worth noting that the choice of initial antihypertensive therapy may depend on various factors, including the presence of comorbidities, and the patient's individual characteristics, as highlighted in the 2007 ESH/ESC guidelines for the management of arterial hypertension 1. However, according to the most recent and highest-quality evidence, ARBs are a suitable option for initial antihypertensive therapy in patients with hypertension and no other comorbidities 1.
Some key points to consider when using ARBs as initial antihypertensive therapy include:
- Starting with a low dose and titrating up as needed to minimize side effects
- Monitoring patients for potential side effects, such as hypotension, hyperkalemia, and changes in renal function
- Emphasizing lifestyle modifications, including reduced sodium intake, regular exercise, and weight management, alongside medication therapy
- Considering the patient's individual characteristics and comorbidities when selecting an initial antihypertensive therapy.
Overall, ARBs are a viable option for initial antihypertensive therapy in patients with hypertension and no other comorbidities, and can be used in place of lisinopril, with careful consideration of the patient's individual needs and characteristics.
From the Research
Initial Antihypertensive Therapy with ARB
- An Angiotensin Receptor Blocker (ARB) can be used as initial antihypertensive therapy in a 55-year-old patient with hypertension and no other comorbidities, instead of lisinopril, as suggested by 2.
- The choice of initial antihypertensive drug should be made on the basis of sound scientific data and from the patient's perspective and needs, with consideration of the drug's efficacy, side effects, and dosing frequency.
Starting Dose for ARB in a 55-year-old Patient
- The starting dose for an ARB in a 55-year-old patient is not explicitly stated in the provided studies, but it is generally recommended to start with a low dose and titrate as needed to achieve blood pressure goals.
- For example, losartan, an ARB, can be started at a dose of 50 mg/day, as used in the study 3.
Comparison with Lisinopril
- Lisinopril, an angiotensin-converting enzyme inhibitor (ACEI), has been shown to be effective in older patients with essential hypertension, including those with low-renin levels 4.
- However, the choice between an ARB and an ACEI, such as lisinopril, depends on individual patient characteristics, comorbidities, and preferences, as well as the specific clinical scenario.
Combination Therapy
- Combination therapy with an ARB and a diuretic or calcium channel blocker may be considered for patients whose blood pressure is not adequately controlled with monotherapy, as suggested by 5 and 3.
- The choice of combination therapy should be based on the patient's individual needs and response to treatment, as well as the potential benefits and risks of each combination.