Is losartan 100mg/hydrochlorothiazide 25mg suitable for controlling hypertension in a patient with Nexplanon (etonogestrel implant)?

Management of Severe Hypertension in a 43-Year-Old Female with Nexplanon

Losartan 100mg/hydrochlorothiazide 25mg is an appropriate and effective treatment option for controlling blood pressure in a patient with Nexplanon implant and severe hypertension (169/122 mmHg). 1

Treatment Approach for Severe Hypertension

• For patients with severe hypertension (BP ≥160/100 mmHg), prompt initiation of antihypertensive medication is essential to reduce cardiovascular risk 1
• The 2024 ESC guidelines recommend combination therapy as initial treatment for most patients with confirmed hypertension (BP ≥140/90 mmHg), particularly for those with stage 2 or 3 hypertension 1
• A combination of a renin-angiotensin system (RAS) blocker (such as losartan) with a thiazide diuretic (such as hydrochlorothiazide) is one of the preferred initial combinations 1

Efficacy of Losartan/HCTZ for Severe Hypertension

• Losartan/HCTZ has demonstrated significant efficacy in treating severe hypertension, with studies showing mean reductions in systolic/diastolic BP of 25.4/18.4 mmHg 2
• The combination of losartan 100mg with HCTZ 25mg provides additive blood pressure-lowering effects through complementary mechanisms of action 3
• In patients with high cardiovascular risk, losartan 100mg/HCTZ 25mg has shown good efficacy regardless of comorbidities 4

Safety Considerations with Nexplanon

• There are no specific contraindications to using losartan/HCTZ in patients with etonogestrel implants (Nexplanon) 1
• Angiotensin receptor blockers (ARBs) like losartan are generally well-tolerated with fewer side effects than many other antihypertensive medications 1, 5
• Unlike some beta-blockers and calcium channel blockers that may have interactions with hormonal contraceptives, ARBs and thiazide diuretics do not have significant interactions with Nexplanon 1

Blood Pressure Targets

• The 2024 ESC guidelines recommend targeting systolic BP to 120-129 mmHg for most adults, provided the treatment is well tolerated 1
• Diastolic BP should be targeted to <80 mmHg 1
• If the target BP cannot be achieved with losartan/HCTZ alone, adding a third agent (typically a calcium channel blocker) should be considered 1

Monitoring and Follow-up

• Close monitoring is required initially, with BP reassessment within 1 month of starting therapy for severe hypertension 1
• Monitor for potential side effects of losartan/HCTZ, including electrolyte disturbances (particularly hypokalemia), dizziness, and renal function changes 5
• Assess for orthostatic hypotension, especially when initiating therapy, by measuring BP in both sitting and standing positions 1

Important Caveats and Considerations

• Avoid combining losartan with ACE inhibitors or direct renin inhibitors, as dual RAS blockade is not recommended 1
• If BP control is not achieved with the current regimen, consider adding a calcium channel blocker rather than increasing doses beyond losartan 100mg/HCTZ 25mg 1
• Losartan may have the additional benefit of lowering uric acid levels, which can counteract the uric acid-elevating effect of hydrochlorothiazide 5
• Consider taking the medication at a consistent time each day to establish a habitual pattern and improve adherence 1

In conclusion, losartan 100mg/HCTZ 25mg is an effective and appropriate choice for managing severe hypertension in this 43-year-old female patient with Nexplanon, with good efficacy, tolerability, and no significant interactions with the contraceptive implant.