What is the starting dose of olmesartan (angiotensin II receptor antagonist) for adults with hypertension?

Starting Dose of Olmesartan 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
• Maximum dose: 40 mg once daily if further blood pressure reduction is needed after 2 weeks of therapy
• Doses above 40 mg do not appear to provide additional benefit 1
• Once-daily dosing is sufficient (twice-daily dosing offers no advantage over the same total dose given once daily) 1

Special Populations Requiring Lower Starting Dose

For patients with possible intravascular volume depletion (e.g., patients treated with diuretics, particularly those with impaired renal function), consider:

• Starting with a lower dose
• Initiating therapy under close medical supervision 2, 1

Dose Titration

• Evaluate response to treatment at monthly intervals until blood pressure control is achieved 2
• If blood pressure is not adequately controlled after 2 weeks on the initial 20 mg dose, increase to 40 mg once daily 2, 1
• Uptitration from 20 mg to 40 mg provides additional clinically significant blood pressure reductions in patients with inadequate response to the initial dose 2

Combination Therapy Considerations

• For patients with stage 2 hypertension and blood pressure more than 20/10 mm Hg above target, consider initiation with 2 first-line agents of different classes 2
• If monotherapy with olmesartan 20 mg does not achieve adequate blood pressure control, consider adding hydrochlorothiazide 12.5 mg 2
• The combination of olmesartan 40 mg and hydrochlorothiazide 12.5 mg has demonstrated superior efficacy to olmesartan 40 mg monotherapy 2, 3

Monitoring Recommendations

• Monitor serum creatinine, estimated glomerular filtration rate, and potassium levels at baseline and at least annually, especially in patients with pre-existing renal disease 2
• Pay particular attention to potential changes in renal function and electrolyte levels when taking olmesartan, especially in those with pre-existing renal disease or those taking other medications that may affect renal function or electrolyte balance 2

Precautions and Contraindications

• Contraindicated in pregnancy due to risk of fetal toxicity 2
• Use with caution in patients with bilateral renal artery stenosis due to risk of acute renal failure 2
• Use with caution in patients with renal insufficiency or those taking potassium-sparing agents due to risk of hyperkalemia 2
• Patients of African descent may have a reduced response to olmesartan, similar to other angiotensin II receptor blockers 2

Olmesartan has demonstrated effective blood pressure control throughout the 24-hour dosage interval, including during the last 4 hours of this period, making it a valuable option for the treatment of adult patients with hypertension 4.