Side effects of losartan hctz

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Side Effects of Losartan HCTZ

Introduction to Losartan HCTZ

Losartan, often combined with hydrochlorothiazide (HCTZ), is a widely used medication for managing hypertension. This combination leverages the angiotensin II receptor-blocking properties of losartan and the diuretic effects of HCTZ to effectively lower blood pressure. However, like all medications, it comes with potential side effects.

Common Side Effects

Dizziness

One of the most frequently reported side effects of losartan, whether used alone or in combination with HCTZ, is dizziness. Clinical trials have shown that the incidence of dizziness in patients taking losartan is slightly higher than in those taking a placebo (2.4% vs. 1.3%) . This side effect is generally mild and tends to diminish as the body adjusts to the medication.

Cough

Patients switching to losartan/HCTZ from other antihypertensive therapies, particularly those involving ACE inhibitors, often report a significant reduction in the occurrence of cough. This improvement is notably greater with losartan/HCTZ compared to enalapril/HCTZ .

Metabolic Effects

Uric Acid Levels

Losartan has a unique effect on uric acid levels. Unlike many other antihypertensive agents, losartan can decrease serum uric acid and increase its excretion, which is beneficial for patients with thiazide-induced hyperuricemia. Studies have shown that losartan does not increase the risk of acute urate nephropathy, making it a safer option for patients with elevated uric acid levels .

Blood Glucose and Lipid Levels

In diabetic patients, the combination of losartan and HCTZ has been shown to manage blood pressure effectively without significant adverse metabolic effects. Both treatments significantly reduced urinary albumin excretion and improved arterial stiffness, with no notable differences in metabolic changes between monotherapy and combination therapy .

Serious Adverse Events

Severe Hypertension Management

In patients with severe hypertension, losartan/HCTZ has been found to be effective and well-tolerated. However, drug-related adverse experiences were reported in 22.9% of patients, with serious adverse experiences occurring in 1.5% of cases. Despite these occurrences, the overall discontinuation rate due to adverse effects was relatively low at 4.6% .

Exercise Tolerance and Quality of Life

In patients with left ventricular diastolic dysfunction and exertional hypertension, losartan has been shown to improve exercise tolerance and quality of life significantly. In contrast, HCTZ alone did not show similar benefits and was associated with a decrease in oxygen consumption .

Conclusion

Losartan combined with HCTZ is generally well-tolerated and effective in managing hypertension, with a side effect profile that includes dizziness and a beneficial impact on uric acid levels. While serious adverse events are rare, they do occur and should be monitored. The combination therapy is particularly advantageous for patients with metabolic concerns and those experiencing side effects from other antihypertensive medications.

Sources and full results

Most relevant research papers on this topic

Efficacy and safety of losartan.

Losartan is an effective and well-tolerated antihypertensive agent, with a smooth antihypertensive profile and similar effects to other drugs, with dizziness being the most common adverse experience.

RCTLarge Human Trial

1995·

17citations

·A. Goldberg et al.

Increased efficacy and tolerability with losartan plus hydrochlorothiazide in patients with uncontrolled hypertension and therapy-related symptoms receiving two monotherapies.

Losartan 100 mg/HCTZ 25 mg improves blood pressure control and reduces side effects in patients with moderate to severe hypertension.

RCT

1999·

21citations

·D. Naidoo et al.

Safety of losartan in hypertensive patients with thiazide-induced hyperuricemia.

Losartan safely decreased serum uric acid and increased uric acid excretion without increasing urinary dihydrogen urate, the primary risk factor for acute urate nephropathy.

RCTHighly Cited

1999·

78citations

·S Shahinfar et al.

A double-blind, randomized study evaluating losartan potassium monotherapy or in combination with hydrochlorothiazide versus placebo in obese patients with hypertension*

Losartan alone or in combination with hydrochlorothiazide is generally well-tolerated and effective in treating elevated systolic and diastolic blood pressure in obese patients with hypertension.

RCT

2008·

9citations

·S. Oparil et al.

Effect of losartan and hydrochlorothiazide on exercise tolerance in exertional hypertension and left ventricular diastolic dysfunction.

Losartan improves exercise tolerance and quality of life in patients with diastolic dysfunction and hypertensive responses to exercise, while hydrochlorothiazide does not.

RCT

2006·

51citations

·W. Little et al.

One-year effectiveness and safety of open-label losartan/hydrochlorothiazide combination therapy in Japanese patients with hypertension uncontrolled with ARBs or ACE inhibitors

Losartan/hydrochlorothiazide combination therapy effectively lowers blood pressure and maintains blood pressure goals in Japanese patients with uncontrolled hypertension, with acceptable safety and tolerability.

Non-RCT

2010·

30citations

·T. Kita et al.

Safety and benefits of a tablet combining losartan and hydrochlorothiazide in Japanese diabetic patients with hypertension

The tablet combining losartan and hydrochlorothiazide significantly reduces blood pressure and offers similar benefits to losartan monotherapy for Japanese diabetic patients with hypertension.

RCT

2009·

21citations

·Kenichiro Kinouchi et al.

Antihypertensive effects of two fixed-dose combinations of losartan and hydrochlorothiazide versus hydrochlorothiazide monotherapy in subjects with ambulatory systolic hypertension.

Combinations of L 50/HCTZ 12.5 and L 100/HCTZ 25 significantly reduced ambulatory systolic blood pressure more effectively than hydrochlorothiazide monotherapy, with a clear dose-response relationship.

RCT

2003·

31citations

·Yves Lacourcière et al.

Efficacy and safety of losartan/hydrochlorothiazide in patients with severe hypertension.

Losartan/hydrochlorothiazide is effective and well-tolerated in treating severe hypertension, either alone or in combination with other antihypertensive agents.

Non-RCT

2001·

24citations

·S. Oparil et al.

563 COMPARISON OF EFFECTS OF LOSARTAN 50 MG/HYDROCHLOROTHIAZIDE 12.5 MG AND CANDESARTAN 8 MG/ HYDROCHLOROTHIAZIDE 6.25 MG ON PLASMA LEVELS AND URINARY EXCRETION OF URIC ACID IN JAPANESE HYPERTENSIVE PATIENTS WITH TYPE 2 DIABETES MELLITUS

Losartan 50 mg may have a greater ability to decrease uric acid levels than 6.25 mg of hydrochlorothiazide, highlighting the importance of considering small differences in HCTZ dosage for hypertensive patients with hyperuricemia and chronic kidney disease.

Non-RCTVery Rigorous Journal

2012·

0citations

·T. Ohori et al.

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