Lisinopril dosing frequency
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Lisinopril Dosing Frequency for Hypertension
Once-Daily vs. Twice-Daily Lisinopril Dosing: Blood Pressure Control
Research comparing once-daily and twice-daily dosing of lisinopril for hypertension shows mixed results. One study found that twice-daily dosing (20 mg twice daily) led to greater reductions in both systolic and diastolic blood pressure compared to the same total daily dose given once daily (40 mg once daily), with a 10.2 mm Hg greater reduction in systolic blood pressure and a 4.3 mm Hg greater reduction in diastolic blood pressure for the twice-daily group . However, a larger real-world study found no significant difference in blood pressure control between once-daily and twice-daily dosing regimens, with mean differences in systolic and diastolic blood pressure being minimal and not statistically significant .
Safety and Adverse Effects with Different Dosing Frequencies
Safety profiles for once-daily and twice-daily dosing are generally similar, but there are some differences. The real-world study noted that twice-daily dosing at 10 mg twice daily was associated with a higher risk of angioedema compared to 20 mg once daily (odds ratio 2.27) . Overall, lisinopril is considered safe and well-tolerated, with the most common side effects being cough, dizziness, and headache, regardless of dosing frequency .
Dose-Response Relationship and Duration of Effect
Lisinopril’s antihypertensive effect is dose-related, with higher doses producing greater blood pressure reductions. Studies show that 10 mg and 20 mg daily doses have similar peak effects, while 80 mg daily produces a greater effect. The antihypertensive response is maintained over 24 hours, supporting once-daily dosing for most patients . In patients on hemodialysis, supervised dosing three times weekly also provided sustained blood pressure control over 44 hours .
Clinical Recommendations and Real-World Practice
Most patients achieve adequate blood pressure control with once-daily dosing, and dose titration is recommended to optimize response. In a large postmarketing study, 68.6% of patients responded to 10 mg/day, 26.3% to 20 mg/day, and only 3.2% required 40 mg/day . Twice-daily dosing may be considered if once-daily dosing is insufficient, but evidence does not consistently show superior effectiveness or safety for twice-daily regimens 12.
Conclusion
Lisinopril is effective for hypertension when taken once daily, and most patients achieve good blood pressure control with this regimen. While twice-daily dosing may provide slightly greater reductions in some cases, large studies do not show a significant advantage in effectiveness or safety. Dose titration remains important, and the choice between once-daily and twice-daily dosing should be individualized based on patient response and tolerance 1235.
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