From the Guidelines
When converting from Lisinopril 40 mg to Losartan, the recommended starting dose is Losartan 50 mg once daily, which can be titrated up to Losartan 100 mg once daily if blood pressure control is inadequate, as supported by the most recent guidelines 1. This recommendation is based on the understanding that Lisinopril and Losartan have different mechanisms of action within the renin-angiotensin system, with Losartan typically causing fewer side effects like cough compared to Lisinopril, an ACE inhibitor 1. The transition from Lisinopril to Losartan should be made directly, stopping Lisinopril and starting Losartan the next day without overlap, to maintain continuous blood pressure control and minimize potential fluctuations. Key considerations include:
- Monitoring blood pressure closely during the first week of transition and scheduling a follow-up with the healthcare provider within 2-4 weeks to assess the effectiveness of the new medication regimen.
- Maintaining other blood pressure management strategies, such as sodium restriction and regular exercise, to support the efficacy of Losartan.
- Recognizing that Losartan may be slightly less potent at the initial dose, necessitating monitoring and possible dose adjustment to achieve optimal blood pressure control. The most recent and highest quality study, from 2018, provides the basis for this recommendation, emphasizing the importance of evidence-based practice in guiding clinical decisions 1.
From the Research
Conversion from Lisinopril to Losartan
- The conversion from Lisinopril 40 mg to Losartan is not directly addressed in the provided studies, but we can look at the general comparison between ACE inhibitors (like Lisinopril) and ARBs (like Losartan) for hypertension treatment 2, 3, 4.
- A study from 2020 found that there were no differences in systolic/diastolic blood pressure between twice-daily and once-daily dosing of Lisinopril and Losartan, with absolute differences in mean systolic BP ranging from -1.8 to 0.7 mmHg and diastolic BP ranging from -1.1 to 0.1 mmHg 2.
- Another study from 2014 compared ACE inhibitors and ARBs for primary hypertension and found no evidence of a difference between the two for total mortality, total cardiovascular events, or cardiovascular mortality, but ARBs had a slightly lower incidence of withdrawals due to adverse effects 3.
- A 2019 article discussed the management of potassium and renal function in patients taking ACE inhibitors and ARBs, highlighting the importance of monitoring these parameters in patients with hypertension and other conditions 5.
- A systematic review from 2008 compared the effectiveness of ACE inhibitors and ARBs for treating essential hypertension and found that they had similar long-term effects on blood pressure, but ACE inhibitors were associated with a greater risk of cough 4.
Key Considerations
- When converting from Lisinopril to Losartan, it's essential to consider the individual patient's response to the medication, as well as potential side effects and interactions 3, 4.
- Monitoring of blood pressure, potassium levels, and renal function is crucial when initiating or switching between these medications 5.
- The choice between Lisinopril and Losartan should be based on the patient's specific needs and medical history, as well as the potential benefits and risks associated with each medication 2, 3, 4.