Abstract
BackgroundLisinopril and losartan manufacturer labels recommend twice-daily dosing (BID) if once-daily (QDay) is insufficient to lower blood pressure (BP).Methods and resultsRetrospective cohort study of patients taking QDay lisinopril and losartan who experienced a dose-doubling (index date). A text-processing tool categorized BID and QDay groups at the index date based on administration instructions. We excluded: pregnant/hospice, regimens other than BID/QDay, and without BP measurements -6 months/+12 months of the index date. The most proximal BP measurements -6 months and +2 weeks to 12 months of the index date were used to evaluate BP differences. Propensity scores were generated, and differences in BP and adverse events (angioedema, acute kidney injury, hyperkalemia) between BID/QDay groups were analyzed within dosing cohorts using inverse propensity of treatment-weighted regression models. Of 11,210 and 6,051 patients who met all criteria for lisinopril and losartan, 784 (7.0%) and 453 (7.5%) were taking BID, respectively. BID patients were older and had higher comorbidity and medication burdens. There were no differences in systolic/diastolic BP between BID and QDay, 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 (all 95% confidence intervals [CI] cross 0). Lisinopril 10mg BID was associated with an increased odds of angioedema compared to lisinopril 20mg QDay (odds ratio 2.27, 95%CI 1.13–4.58).ConclusionsAdjusted models do not support improved effectiveness or safety of BID lisinopril and losartan.
Highlights
High blood pressure (BP) remains the leading modifiable risk factor for cardiovascular morbidity and mortality globally [1, 2], even though effective and safe antihypertensive medications are generic, widely available, and low-cost
We previously reported that lisinopril 20mg twice-daily is more effective than 40mg oncedaily, with an average 10.2 mmHg difference in systolic BP (SBP) between the groups [9]
Data were obtained from the Kaiser Permanente Colorado (KPCO) Virtual Data Warehouse (VDW), a data repository used for clinical research containing structured and unstructured data from within and external to the health system [10]
Summary
High blood pressure (BP) remains the leading modifiable risk factor for cardiovascular morbidity and mortality globally [1, 2], even though effective and safe antihypertensive medications are generic, widely available, and low-cost. The respective half-lives of lisinopril and losartan are twelve and nine hours, indicating that twice-daily dosing may be more effective than once-daily if the latter does not achieve optimal BP lowering, as suggested by the manufacturer labels [4, 5]. We previously reported that lisinopril 20mg twice-daily is more effective than 40mg oncedaily, with an average 10.2 mmHg difference in systolic BP (SBP) between the groups [9]. Lisinopril and losartan manufacturer labels recommend twice-daily dosing (BID) if oncedaily (QDay) is insufficient to lower blood pressure (BP)
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
