Losartan as First-Choice Antihypertensive

Guideline-Based Recommendations

The European Society of Cardiology recommends angiotensin receptor blockers, including losartan, as first-line treatments for hypertension alongside ACE inhibitors, dihydropyridine calcium channel blockers, and thiazide diuretics 1
The European Society of Hypertension and European Society of Cardiology guidelines state that drug treatment can be initiated with thiazide diuretics, calcium antagonists, angiotensin receptor antagonists, ACE inhibitors, and beta-blockers in elderly patients with hypertension 2

In the LIFE trial, losartan demonstrated superiority over atenolol in reducing cardiovascular events, particularly stroke, in hypertensive patients with left ventricular hypertrophy 3, 2
The American Heart Association and European Society of Cardiology recommend losartan for reducing cardiovascular events in hypertensive patients with left ventricular hypertrophy 3, 2

In diabetic hypertensive patients, a blocker of the renin-angiotensin system, such as an ARB or ACE inhibitor, should be a regular component of combination treatment, as recommended by the European Society of Cardiology 3
The European Society of Cardiology suggests that losartan has pronounced benefits in the diabetic subpopulation, with statistically significant differences in all-cause mortality 4

Losartan is particularly indicated in hypertensive patients with electrocardiographic left ventricular hypertrophy, where it has proven superiority over beta-blockers for reducing cardiovascular events, according to the European Society of Cardiology 3, 2

Losartan has a significantly lower incidence of cough compared to ACE inhibitors, making it an excellent alternative for patients intolerant of ACE inhibitors, as noted by the European Society of Cardiology 5, 6

Renal function monitoring is essential with ARBs, such as losartan, as with ACE inhibitors, and should be performed before initiation and periodically during treatment, especially in patients with renal impairment, as recommended by the European Society of Cardiology 5, 6
Blood pressure should be measured in both sitting and standing positions, particularly in elderly patients, due to increased risk of postural hypotension, according to the European Society of Cardiology 3, 2

Losartan is contraindicated in pregnancy, and the American College of Obstetricians and Gynecologists recommends avoiding its use during pregnancy 1
The European Society of Cardiology warns of the risk of hyperkalemia, especially in patients with chronic kidney disease, and recommends careful monitoring of potassium levels 1
The American Heart Association and European Society of Cardiology advise against combining losartan with ACE inhibitors or aliskiren due to increased adverse events without additional benefit 1