Olmesartan Dosing for Hypertension
The recommended starting dose of olmesartan for hypertension is 20 mg once daily, with a maximum effective dose of 40 mg once daily. 1
Standard Dosing Protocol
- Initial dose: 20 mg once daily
- Titration: May increase to 40 mg once daily after 2 weeks if blood pressure control is inadequate
- Maximum dose: 40 mg once daily (doses above 40 mg do not appear to have greater effect) 1
Special Populations
Volume-Depleted Patients
- For patients with possible intravascular volume depletion (e.g., those treated with diuretics):
- Start with lower dose
- Initiate under close medical supervision 1
Heart Failure Patients
- Target dose: 40 mg once daily
- Minimum effective dose (50% of target): 20 mg once daily 2
Efficacy Considerations
Olmesartan has demonstrated significant blood pressure lowering effects at the 20-40 mg daily dose range:
- In clinical trials, olmesartan 20 mg once daily produced mean reductions of 11.8 mmHg in diastolic BP and 17.1 mmHg in systolic BP after 8 weeks of treatment 3
- For patients who don't achieve adequate BP control with 20 mg daily, increasing to 40 mg daily has shown additional benefit, with response rates of 62% 4
Combination Therapy
If blood pressure is not adequately controlled with olmesartan monotherapy:
- Consider adding hydrochlorothiazide 12.5 mg daily
- Fixed-dose combinations are preferred to improve adherence 2
- Combination therapy with olmesartan 20 mg plus hydrochlorothiazide 12.5 mg has shown greater efficacy than olmesartan 40 mg monotherapy in non-responders to initial therapy 4
Clinical Pearls
- Olmesartan has a half-life of approximately 13 hours, making it suitable for once-daily administration 5
- Twice-daily dosing offers no advantage over the same total dose given once daily 1
- When compared to other ARBs at recommended doses, olmesartan has demonstrated greater blood pressure reductions in head-to-head trials 6, 7
- As with all antihypertensive medications, the goal is to achieve target blood pressure of <130/80 mmHg for most adults 2
Common Pitfalls to Avoid
- Don't combine olmesartan with other renin-angiotensin system blockers (ACE inhibitors or other ARBs) as this combination is not recommended and potentially harmful 2
- Don't start with high doses in volume-depleted patients, as this may cause hypotension
- Don't exceed 40 mg daily as higher doses don't provide additional benefit 1
- Don't discontinue therapy once blood pressure is controlled, as antihypertensive treatment should be maintained lifelong if well tolerated 2