What is the dose of Angiotensin II Receptor Blocker (ARB) for hypertension?

From the Guidelines

The dose of Angiotensin II Receptor Blocker (ARB) for hypertension is typically in the range of 20-320 mg daily, depending on the specific medication and individual patient needs.

Key Points

• The starting dose for most ARBs is lower, around 16-80 mg daily, with the goal of titrating up to the higher end of the dose range as needed and tolerated [ 1 ].
• Common ARBs and their usual dose ranges include:
  • Candesartan: 8-32 mg daily [ 1 ]
  • Irbesartan: 150-300 mg daily [ 1 ]
  • Losartan: 50-100 mg daily [ 1 ]
  • Valsartan: 80-320 mg daily [ 1 ]
• The choice of ARB and dose should be individualized based on patient factors, such as kidney function, blood pressure goals, and presence of other medical conditions [ 1 ].
• It's essential to monitor blood pressure and adjust the dose as needed to achieve optimal blood pressure control, typically < 130/80 mmHg [ 1 ].

From the Research

Dose of Angiotensin II Receptor Blocker (ARB) for Hypertension

• The dose of ARB for hypertension varies depending on the specific medication and the patient's response to treatment 2, 3, 4, 5, 6.
• Studies have shown that a dose of 1/8 or 1/4 of the manufacturer's maximum recommended daily dose can achieve 60-70% of the blood pressure lowering effect of the maximum dose 3.
• A dose of 1/2 of the maximum recommended daily dose can achieve 80% of the blood pressure lowering effect of the maximum dose 3.
• The antihypertensive potency of ARBs follows the sequence: candesartan cilexetil > telmisartan approximately = losartan > irbesartan approximately = valsartan > eprosartan 2.
• The daily mg dose of ARBs can vary, with some common doses including:
  • Losartan: 50-100 mg 4, 6
  • Valsartan: 160-320 mg 6
  • Candesartan cilexetil: 16-32 mg 2
  • Irbesartan: 150-300 mg 2
  • Telmisartan: 40-80 mg 2
• It's worth noting that the dose-response curve with ARBs is shallow, and uptitration may only marginally enhance the antihypertensive efficacy 4.

Blood Pressure Lowering Efficacy

• The blood pressure lowering efficacy of ARBs can vary depending on the specific medication and dose 3, 4, 6.
• Studies have shown that ARBs can lower systolic blood pressure by 8-15 mmHg and diastolic blood pressure by 5-11 mmHg 3, 4, 6.
• The efficacy of ARBs is similar to that of other antihypertensive agents, such as angiotensin-converting enzyme inhibitors and calcium channel blockers 2, 5.

Comparison of ARBs

• Studies have compared the efficacy of different ARBs, including losartan, valsartan, candesartan cilexetil, irbesartan, and telmisartan 4, 6.
• Valsartan 160 mg has been shown to be more effective at lowering blood pressure than losartan 100 mg 6.
• Candesartan cilexetil has been shown to be more effective at lowering blood pressure than irbesartan 150 mg and losartan 100 mg 2, 4.