Olmesartan vs. Losartan for Blood Pressure Control
Olmesartan is more effective than losartan for blood pressure control, demonstrating greater reductions in both systolic and diastolic blood pressure at recommended starting doses. 1, 2
Comparative Efficacy
- Head-to-head trials have consistently shown olmesartan to be more effective than losartan in reducing blood pressure at recommended starting doses (olmesartan 20mg vs. losartan 50mg) 2
- In a multicenter, randomized, double-blind trial with 588 patients, olmesartan 20mg produced significantly greater reductions in diastolic blood pressure (11.5 mmHg) compared to losartan 50mg (8.2 mmHg) 2
- 24-hour ambulatory blood pressure monitoring (ABPM) showed olmesartan achieved superior blood pressure control throughout the entire 24-hour dosing interval compared to losartan 3
- Olmesartan demonstrated faster onset of action compared to losartan and other ARBs in terms of blood pressure reduction 4
Dosing Considerations
- At week 8 of a forced-titration study, olmesartan 40mg once daily reduced mean seated diastolic blood pressure more effectively than losartan 100mg once daily 5
- More patients achieved the target blood pressure goal of <140/90 mmHg with olmesartan compared to losartan (P<0.001) 5
- Higher doses of losartan (50mg twice daily) were needed to achieve comparable blood pressure reductions to olmesartan 40mg once daily by week 12 5
Clinical Implications
- European guidelines acknowledge that different ARBs may have varying efficacy, though they generally focus on the class effect rather than comparing individual agents 6
- The LIFE study showed losartan was effective in reducing cardiovascular events compared to atenolol in hypertensive patients with left ventricular hypertrophy, but did not compare it to olmesartan 6
- Olmesartan maintains larger decreases in blood pressure during the morning surge period (last 2-4 hours of the dosing interval), which may be clinically significant for cardiovascular risk reduction 3
Safety Considerations
- Both medications are generally well-tolerated with similar safety profiles as part of the ARB class 4
- The American College of Cardiology acknowledges that ARBs can cause angioedema, though at a lower incidence than ACE inhibitors 7
- For patients with a history of ACE inhibitor-induced angioedema who require RAAS blockade, ARBs like olmesartan or losartan may be considered after a 6-week washout period 7
Practical Approach to Selection
- For patients requiring more potent blood pressure reduction with once-daily dosing, olmesartan would be the preferred choice over losartan 2, 3
- For patients with left ventricular hypertrophy, losartan has specific outcome data from the LIFE trial, though olmesartan's superior blood pressure control may still make it preferable 6, 3
- When cost is a consideration, losartan (available generically) may be more accessible, though potentially at the expense of less consistent 24-hour blood pressure control 3
In summary, when choosing between olmesartan and losartan specifically for blood pressure control, the evidence clearly favors olmesartan for its superior efficacy in reducing both systolic and diastolic blood pressure, more consistent 24-hour control, and better achievement of target blood pressure goals.