Management of Hypertension in Adults

Assessment and Treatment

• The International Society of Hypertension recommends maximizing the first-line agent before adding a second medication, and losartan can be safely increased from 50mg to 100mg once daily for patients with inadequate blood pressure control 1, 2
• For non-black patients with inadequate BP control on low-dose ARB therapy, the next step is to increase to the full dose of the ARB before adding another agent, with a target BP of <130/80 mmHg 1, 5
• If BP remains uncontrolled after 2-4 weeks on losartan 100mg daily, add a thiazide/thiazide-like diuretic, such as hydrochlorothiazide 12.5mg or indapamide 2.5mg 1, 3, 4
• The American Heart Association and other guideline societies support the use of thiazide diuretics as an effective addition to ARB therapy for blood pressure management 1, 3
• Reassess BP in 2-4 weeks after increasing the dose, and proceed to add a thiazide diuretic as the next step if BP remains uncontrolled 1, 3, 5
• Check medication adherence before increasing the dose, as non-adherence is a common cause of treatment failure, according to the International Society of Hypertension guidelines 5