From the Guidelines
The maximum dose of lisinopril for hypertension is 40 mg once daily. This recommendation is based on the most recent and highest quality study, which is the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults 1. According to this guideline, the usual dose range for lisinopril is 10-40 mg per day, taken once daily.
Key Considerations
- Treatment typically starts at a lower dose of 10 mg once daily, which can be gradually increased based on blood pressure response.
- For patients already taking diuretics, the recommended starting dose is lower (5 mg) to prevent excessive blood pressure reduction.
- Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor that works by preventing the conversion of angiotensin I to angiotensin II, thereby reducing vasoconstriction and sodium retention.
- This medication is best taken at the same time each day, and patients should be monitored for potential side effects including dry cough, dizziness, hyperkalemia, and angioedema.
- Blood pressure, kidney function, and potassium levels should be checked periodically.
- Patients should be aware that the full therapeutic effect may take several weeks to develop, and medication should not be discontinued without consulting a healthcare provider.
Additional Guidance
While the 2020 International Society of Hypertension global hypertension practice guidelines provide additional recommendations for managing resistant hypertension 1, they do not specifically address the maximum dose of lisinopril. Therefore, the guideline from 1 remains the most relevant and highest quality study for determining the maximum dose of lisinopril for hypertension.
From the FDA Drug Label
DOSAGE & ADMINISTRATION 2. 1 Hypertension Initial Therapy in adults: The recommended initial dose is 10 mg once a day. Dosage should be adjusted according to blood pressure response. The usual dosage range is 20 mg to 40 mg per day administered in a single daily dose. Doses up to 80 mg have been used but do not appear to give greater effect The maximum dose of lisinopril for hypertension is 80 mg per day, although doses above 40 mg do not appear to have a greater effect 2.
- The usual dosage range is 20 mg to 40 mg per day.
- Doses above 40 mg do not appear to give greater effect.
From the Research
Maximum Dose of Lisinopril for Hypertension
- The maximum dose of lisinopril for hypertension is not explicitly stated in the provided studies, but the dose range can be inferred from the study results.
- In the study published in the Journal of human hypertension 3, the dose of lisinopril was increased to a maximum of 40 mg once daily as required.
- The study published in the Journal of clinical hypertension (Greenwich, Conn.) 4 compared the efficacy and safety of twice- vs once-daily dosing of lisinopril for hypertension, with doses ranging from 20 mg to 40 mg.
- Another study published in PloS one 5 also compared twice-daily versus once-daily lisinopril and losartan for hypertension, with doses ranging from 10 mg to 20 mg.
Dosing Frequency and Efficacy
- The study published in the Journal of clinical hypertension (Greenwich, Conn.) 4 found that twice-daily administration of lisinopril was associated with greater systolic blood pressure reductions compared with the same total daily dose administered once daily.
- However, the study published in PloS one 5 found no differences in systolic/diastolic BP between twice-daily and once-daily dosing of lisinopril, 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.
Safety and Adverse Events
- The study published in the Journal of human hypertension 3 reported no significant ECG alterations and no major side effects occurred with lisinopril treatment.
- The study published in PloS one 5 found that lisinopril 10mg twice daily was associated with an increased odds of angioedema compared to lisinopril 20mg once daily.