Is 75mg of losartan an appropriate dose for treating hypertension?

Losartan 75mg Dosing for Hypertension

75mg of losartan is not a standard recommended dose for hypertension treatment. The target dose for losartan in hypertension is 100mg once daily, with 50mg being a common starting dose. 1

Standard Dosing Guidelines for Losartan

According to the 2020 ACC/AHA guidelines, losartan dosing for hypertension follows these parameters:

• Starting dose: 50mg once daily
• Target dose: 100mg once daily
• 50% of target dose: 50mg once daily 1

The European Society of Cardiology (ESC) 2024 guidelines also recommend angiotensin receptor blockers (ARBs) like losartan as first-line treatments for hypertension, typically in combination with other agents 1.

Dosing Considerations

Efficacy

• Clinical studies show that losartan 50-100mg once daily effectively lowers blood pressure in patients with mild to moderate hypertension 2
• The antihypertensive effect persists throughout 24 hours with once-daily dosing due to its active metabolite E3174 2
• For optimal clinical outcomes, achieving target doses is critical 3

Titration Protocol

• Start with 50mg once daily
• If blood pressure control is inadequate after 2-4 weeks, increase to 100mg once daily 3
• Monitor blood pressure within 2-4 weeks of initiating therapy or changing dose 3

Special Populations

• Elderly patients should start with lower doses and titrate more gradually 3
• In severe hypertension, losartan may be combined with hydrochlorothiazide or other agents if target blood pressure is not achieved with monotherapy 4

Monitoring Recommendations

• Check renal function (serum creatinine, eGFR) and serum potassium:

  • Before initiating therapy
  • Within 1-2 weeks of starting treatment
  • 1-4 weeks after dose increases 3

• Monitor for potential side effects:

  • Dizziness (most common drug-related side effect) 2
  • Hypotension (uncommon as first-dose effect) 2, 5
  • Hyperkalemia (similar risk as with ACE inhibitors) 3

Clinical Pearls

• Losartan has a favorable side effect profile compared to ACE inhibitors, particularly regarding cough 2, 5
• Long-term studies show losartan is well-tolerated and may provide additional benefits such as reduction in left ventricular mass 6
• The 75mg dose is not a standard recommended dose in major guidelines 1, 3
• For patients requiring more than 50mg but unable to tolerate 100mg, the appropriate approach would be to optimize the regimen with combination therapy rather than using an unconventional 75mg dose

Conclusion

For hypertension treatment, losartan should be prescribed at either 50mg (starting/lower dose) or 100mg (target dose) once daily, not 75mg. If blood pressure control is inadequate with 50mg, titration to 100mg is recommended, or combination therapy should be considered.