Lisinopril Dosing for Hypertension
Lisinopril is not considered a low-dose medication for hypertension, as its standard initial dose is 10 mg daily with a usual dosage range of 20-40 mg per day for adults. 1
Standard Dosing Information
The FDA-approved dosing for lisinopril in hypertension is:
- Initial therapy in adults: 10 mg once daily
- Usual dosage range: 20-40 mg per day administered as a single daily dose
- Maximum dose: Up to 80 mg daily has been used but does not appear to provide greater effect 1
Special Populations:
- Adults taking diuretics: Starting dose of 5 mg once daily
- Pediatric patients (≥6 years): 0.07 mg/kg once daily (up to 5 mg total), with maximum of 0.61 mg/kg (up to 40 mg) once daily
- Renal impairment:
- For creatinine clearance ≥10 mL/min and ≤30 mL/min: Half the usual recommended dose
- For hemodialysis or creatinine clearance <10 mL/min: 2.5 mg once daily 1
Comparative Dosing Context
When examining the dosing ranges of various antihypertensive medications, lisinopril falls into a moderate dosing category:
- The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure does not classify lisinopril as a low-dose medication 2
- In clinical studies, lisinopril was administered at doses of 20-80 mg daily, which is comparable to other standard antihypertensive medications like metoprolol (100-200 mg daily) 1
Efficacy and Clinical Use
- Lisinopril produces greater systolic and diastolic blood pressure reductions compared to hydrochlorothiazide in predominantly Caucasian populations 1
- It is approximately equivalent to atenolol and metoprolol in reducing diastolic blood pressure, with somewhat greater effects on systolic blood pressure 1
- Lisinopril is less effective in reducing blood pressure in Black patients compared to Caucasians 1
- For Black adults with hypertension but without heart failure or chronic kidney disease, a thiazide-type diuretic or calcium channel blocker is recommended as first-line therapy rather than an ACE inhibitor like lisinopril 3
Practical Considerations
- Many patients achieve adequate blood pressure reduction with lisinopril monotherapy, but those who don't typically respond well to the addition of hydrochlorothiazide 4
- Lisinopril attenuates hypokalemia induced by thiazide diuretics 4
- The antihypertensive effect begins within 2 hours, peaks around 6 hours, and lasts for at least 24 hours, making it suitable for once-daily dosing 5
Common Pitfalls and Caveats
- Lisinopril is contraindicated in pregnancy; women of childbearing age should use reliable contraception 3
- Monitor serum potassium and creatinine periodically for hyperkalemia and azotemia 2
- Cough and angioedema are potential side effects, though reportedly less common with newer ACE inhibitors compared to captopril 2
- Significant accumulation occurs in patients with severe renal impairment (creatinine clearance ≤30 mL/min), necessitating dose adjustment 5
- Black patients typically have a less robust response to ACE inhibitors like lisinopril as monotherapy 3
In conclusion, lisinopril with its standard initial dose of 10 mg and usual range of 20-40 mg daily is not considered a low-dose antihypertensive medication, but rather falls into a moderate dosing category among antihypertensive agents.