Losartan dosage for seniors
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Losartan Dosage for Seniors: Clinical Insights and Recommendations
Introduction to Losartan in Elderly Patients
Losartan, an angiotensin II receptor antagonist, is widely used to manage hypertension and heart failure, particularly in elderly patients. This article synthesizes findings from multiple studies to provide a comprehensive overview of the appropriate dosage and clinical implications of losartan for seniors.
Dosage and Titration Strategy
Initial and Target Dosage
In elderly patients, the initial dosage of losartan typically starts at 12.5 mg daily, with a gradual increase to a target dose of 50 mg daily as tolerated . This titration strategy is designed to minimize adverse effects while achieving optimal therapeutic outcomes.
Comparative Efficacy and Safety
Losartan vs. Captopril
The ELITE (Evaluation of Losartan in the Elderly) trial compared losartan with captopril in patients over 65 years with heart failure. The study found that losartan, titrated to 50 mg once daily, was generally better tolerated than captopril, which was administered at 50 mg three times daily . Fewer patients discontinued losartan due to adverse effects compared to captopril (12% vs. 21%, respectively) . Additionally, losartan was associated with a significant reduction in all-cause mortality, primarily due to fewer sudden cardiac deaths .
Adverse Effects and Tolerability
Renal Dysfunction and Hyperkalemia
Both losartan and captopril showed similar incidences of persistent renal dysfunction (10.5%) and hyperkalemia, with slightly fewer patients discontinuing losartan due to these issues . The incidence of adverse reactions was higher in elderly patients, but no specific adverse reactions were unique to this age group.
Quality of Life
A substudy of the ELITE trial focusing on health-related quality of life (HRQoL) found significant improvements in both losartan and captopril groups. However, losartan was generally better tolerated, with fewer patients discontinuing therapy due to adverse effects.
Special Considerations for Hypertensive Elderly Patients
Fixed-Dose Combination Therapy
A post-marketing survey in Japan evaluated the efficacy and safety of a fixed-dose combination of losartan (50 mg) and hydrochlorothiazide (12.5 mg) in elderly patients. The study confirmed significant reductions in systolic and diastolic blood pressure across all age groups, including those over 75 years, without significant differences in the degree of blood pressure change between age groups.
Conclusion
Losartan, starting at 12.5 mg and titrated to 50 mg daily, is effective and well-tolerated in elderly patients with hypertension and heart failure. It offers a favorable safety profile compared to captopril, with fewer discontinuations due to adverse effects and a significant reduction in all-cause mortality. Fixed-dose combinations with hydrochlorothiazide also provide effective blood pressure control in this population. These findings support the use of losartan as a viable first-line therapy for elderly patients, particularly those who are intolerant to ACE inhibitors.
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