Recommended Dosage of Lisinopril for Adults with Hypertension
For adults with hypertension, the recommended initial dose of lisinopril is 10 mg once daily, with a usual maintenance dosage range of 20-40 mg per day administered as a single daily dose. 1
Initial Dosing and Titration
- The FDA-approved starting dose for lisinopril in adults with hypertension is 10 mg once daily 1
- Dosage should be adjusted according to blood pressure response, typically titrating upward to reach the target blood pressure 1
- The usual effective maintenance dosage range is 20-40 mg per day administered as a single daily dose 1
- Although doses up to 80 mg have been used in clinical practice, they do not appear to provide significantly greater antihypertensive effect than the standard dosage range 1
Special Populations and Dosage Adjustments
Patients Taking Diuretics
- For patients already on diuretic therapy, the recommended starting dose is lower: 5 mg once daily 1
- This reduced initial dose helps minimize the risk of hypotension that can occur when adding an ACE inhibitor to diuretic therapy 1
Patients with Renal Impairment
- No dose adjustment is required for patients with creatinine clearance >30 mL/min 1
- For patients with creatinine clearance between 10-30 mL/min, reduce the initial dose to half (5 mg) 1
- For patients on hemodialysis or with creatinine clearance <10 mL/min, the recommended initial dose is 2.5 mg once daily 1, 2
- Patients with severe renal impairment may require lower maintenance doses, with careful monitoring 2, 3
Elderly Patients
- Elderly patients may require lower doses, typically in the range of 2.5-40 mg/day 4
- Age-related differences in antihypertensive efficacy do not appear to be clinically significant, but careful monitoring is advised 4
Combination Therapy Considerations
- If blood pressure is not adequately controlled with lisinopril monotherapy, a low dose of a thiazide diuretic may be added (e.g., hydrochlorothiazide 12.5 mg) 1
- After adding a diuretic, it may be possible to reduce the dose of lisinopril 1
- Combination therapy, preferably with a single pill combination to improve adherence, may be considered as initial treatment in some patients 5
- ACE inhibitors like lisinopril can be effectively combined with diuretics (thiazide or thiazide-like), or long-acting dihydropyridine calcium channel blockers 5
Target Blood Pressure Goals
- The general target blood pressure goal for patients with hypertension without comorbidities is <140/90 mmHg 5
- For patients with known cardiovascular disease, a more intensive target systolic blood pressure goal of <130 mmHg is recommended 5
- For high-risk patients (those with high cardiovascular risk, diabetes mellitus, or chronic kidney disease), a target systolic blood pressure of <130 mmHg may be appropriate 5
Monitoring and Follow-up
- Monthly follow-up is suggested after initiation or change in antihypertensive medications until patients reach their target blood pressure 5
- For patients with stable, controlled blood pressure, follow-up every 3-5 months is recommended 5
- Monitor blood chemistry (urea, creatinine, potassium) and blood pressure regularly, especially after initiation and dose adjustments 5
Common Pitfalls and Considerations
- Avoid simultaneous use of ACE inhibitors with angiotensin receptor blockers (ARBs) or renin inhibitors, as this combination is potentially harmful 5
- Be cautious when initiating lisinopril in patients with significant renal dysfunction, hyperkalaemia, or symptomatic/severe asymptomatic hypotension 5
- ACE inhibitors may be less effective than thiazide diuretics and calcium channel blockers in lowering BP and preventing stroke in black patients 5
- Cough is a common side effect of ACE inhibitors like lisinopril and may require switching to an ARB if severe and persistent 5
- Some increase in blood urea nitrogen, creatinine, and potassium is expected after initiation of an ACE inhibitor; if the increase is small and asymptomatic, no action is necessary 5