Management of Losartan Therapy in Heart Failure and Hypertension

Risks of Abrupt Discontinuation

Abrupt withdrawal of losartan can lead to clinical deterioration in patients with heart failure or hypertension. 1
The 2013 ACC/AHA heart‑failure guideline (Class I recommendation) advises that abrupt cessation of ACE‑inhibitor therapy—and by extension ARBs such as losartan—should be avoided to prevent decompensation. 1

In stable hypertensive patients without contraindications, losartan should be maintained as part of long‑term blood‑pressure control. 2
The 2017 ACC/AHA hypertension guideline lists losartan as a primary antihypertensive agent for survivors of chronic intracerebral hemorrhage. 2
ARBs like losartan are recommended alternatives for patients who cannot tolerate ACE inhibitors. 1

When side effects such as dizziness or a mild rise in serum creatinine (≈10‑20 %) occur, a dose reduction is preferred over abrupt discontinuation. 1
If discontinuation is unavoidable in heart‑failure patients, the drug should be tapered gradually while monitoring clinical status closely. 1
For patients with heart failure or chronic hypertension who tolerate losartan, continue therapy with regular monitoring of renal function, serum potassium, and blood pressure. 1
In the presence of mild adverse effects or borderline laboratory values, reduce the losartan dose rather than stop the medication. 1

Concomitant use of losartan with ACE inhibitors or direct renin inhibitors should be avoided because it increases the risk of hyperkalemia, hypotension, and renal dysfunction without providing additional benefit. 1