How much does losartan typically lower systolic and diastolic blood pressure (in mm Hg)?

Blood Pressure Reduction with Losartan

Losartan 50-100 mg once daily typically lowers blood pressure by approximately 5.5-10.5 mmHg systolic and 3.5-7.5 mmHg diastolic at trough (24 hours post-dose), with peak effects (6 hours post-dose) being moderately larger. 1

Monotherapy Effects

Standard Dosing (50-100 mg once daily)

• Losartan 50-100 mg once daily produces statistically significant mean blood pressure reductions of 5.5-10.5/3.5-7.5 mmHg compared to placebo 1
• The 150 mg dose provides no greater effect than 50-100 mg, establishing an effective ceiling dose 1
• Twice-daily dosing at 50-100 mg/day produces consistently larger trough responses than once-daily dosing at the same total dose 1

Ambulatory Blood Pressure Monitoring Data

• By 24-hour ambulatory monitoring, losartan 50 mg once daily reduces blood pressure by 9.2/6.9 mmHg 2
• Losartan 100 mg once daily reduces blood pressure by 9.9/6.4 mmHg 2
• Losartan 50 mg twice daily reduces blood pressure by 13.2/8.5 mmHg 2

Trough-to-Peak Ratio

• The trough-to-peak ratio ranges from 50-95% for systolic and 60-90% for diastolic responses, indicating sustained 24-hour efficacy 1
• Peak effects at 6 hours are uniformly but moderately larger than trough effects at 24 hours 1

Combination Therapy with Hydrochlorothiazide

Enhanced Efficacy

• Adding hydrochlorothiazide 12.5 mg to losartan 50 mg once daily produces placebo-adjusted blood pressure reductions of 15.5/9.2 mmHg 1
• This combination provides clinically meaningful additional reductions compared to losartan monotherapy 2

African American Population

• In African American patients, losartan monotherapy (50-150 mg) reduces blood pressure by 6.4/6.6 mmHg compared to placebo 3
• The losartan/HCTZ combination produces reductions of 16.8/10.8 mmHg in this population, significantly greater than monotherapy 3

Pediatric Population

• In children weighing <50 kg, doses of 25-50 mg daily reduce diastolic blood pressure by 5-6 mmHg more than the lowest dose (2.5 mg) 1
• In children weighing ≥50 kg, doses of 50-100 mg daily produce similar 5-6 mmHg additional reductions compared to the 5 mg dose 1
• The lowest doses (0.07 mg/kg average) do not offer consistent antihypertensive efficacy 1

Dose-Response Considerations

Suboptimal Dosing

• The commonly prescribed dose of losartan 50 mg daily appears inferior to ACE inhibitors for mortality reduction in heart failure 4
• The optimal dose for heart failure (150 mg daily) is higher than that approved in the US for any cardiovascular indication 4
• Doses used for hypertension (typical range) are lower than target doses demonstrated in heart failure trials 4

Clinical Practice vs. Trial Data

• The most dramatic blood pressure decreases with ARBs occur with the low starting dose, with subsequent dosing increments producing comparatively smaller changes 4
• Medium-range doses do not necessarily provide most of the benefits of target doses, as higher doses have provided greater benefits in clinical trials 4

Race and Age Considerations

• Losartan is effective in reducing blood pressure regardless of race, though the effect is somewhat less in Black patients (typically a low-renin population) 1
• Men and women, and patients over and under 65 years, show generally similar responses 1
• In pediatric patients, no significant differences in antihypertensive effect were detected by age (<12 vs ≥12 years) or gender 1

Comparative Context

LIFE Study Data

• In the LIFE echocardiographic substudy, losartan demonstrated superior left ventricular mass reduction (21.7 g/m²) compared to atenolol (17.7 g/m²) 4
• Blood pressure reductions were similar between losartan and atenolol groups in this trial 4