Olmesartan Starting Dose for Adults with Hypertension
The usual recommended starting dose of olmesartan for adults with hypertension is 20 mg once daily when used as monotherapy in patients who are not volume-contracted. 1
Dosing Guidelines
- Initial dose: 20 mg once daily
- Titration: May increase to 40 mg once daily after 2 weeks if further blood pressure reduction is needed
- Maximum dose: 40 mg daily (doses above 40 mg do not appear to have greater effect)
- Dosing frequency: Once daily (twice-daily dosing offers no advantage over the same total dose given once daily)
Special Populations and Considerations
Volume-Depleted Patients
- For patients with possible depletion of intravascular volume (e.g., patients treated with diuretics):
- Initiate under close medical supervision
- Consider a lower starting dose 1
- Monitor for orthostatic hypotension, especially in older adults
Monitoring After Initiation
- Follow-up evaluation of adherence and response to treatment should occur at monthly intervals until blood pressure control is achieved 2
- Monitor serum creatinine, estimated glomerular filtration rate, and potassium levels at baseline and at least annually, especially in patients with pre-existing renal disease 3
Efficacy
Olmesartan 20 mg once daily has demonstrated significant blood pressure-lowering efficacy:
- Response rate of approximately 70% at the 20 mg dose 4
- Produces significant reductions in both systolic and diastolic blood pressure 3
- Maintains blood pressure control throughout the 24-hour dosage interval 5
When Initial Monotherapy Is Inadequate
If blood pressure is not adequately controlled with olmesartan 20 mg after 2 weeks:
- Increase dose to 40 mg once daily 1, OR
- Consider combination therapy with hydrochlorothiazide (12.5 mg) 3
According to the ACC/AHA guidelines, for patients with stage 2 hypertension and blood pressure more than 20/10 mm Hg above target, initiation with 2 first-line agents of different classes is recommended 2.
Contraindications and Precautions
- Pregnancy: Contraindicated due to risk of fetal toxicity 3
- Bilateral renal artery stenosis: Use with caution due to risk of acute renal failure 3
- Renal insufficiency: Start with caution and monitor renal function 3
- Concomitant medications: Monitor for interactions with potassium-sparing agents due to risk of hyperkalemia 3
Comparative Efficacy
Clinical studies have shown that olmesartan 20 mg provides:
- Better antihypertensive efficacy than losartan 50 mg, with more rapid onset of action 6
- Comparable efficacy to amlodipine 5 mg/day in mild-to-moderate hypertension 7
- Similar efficacy to atenolol 50-100 mg/day in lowering diastolic blood pressure 7
The consistent antihypertensive efficacy throughout the 24-hour dosage interval and good tolerability profile make olmesartan a valuable option for the treatment of adult patients with hypertension 5.