When should losartan be taken for high blood pressure. How does losartan work to lower blood pressure. What are the proper dosages of losartan for adults and children. How to manage missed doses and potential side effects of losartan.

Understanding Losartan: A Powerful Medication for Hypertension Management

Losartan is a widely prescribed medication used to treat high blood pressure, also known as hypertension. This angiotensin receptor blocker (ARB) works by relaxing blood vessels, allowing blood to flow more easily and reducing the workload on the heart. But when is the best time to take losartan, and how should it be used effectively?

The Basics of Losartan Administration

Losartan is typically taken once daily, with or without food. While the timing of the dose can be flexible, consistency is key. Taking losartan at the same time each day helps maintain steady blood levels of the medication, ensuring optimal effectiveness in controlling blood pressure.

• Can be taken with or without food
• Should be swallowed with a glass of water
• Consistency in timing is important for effectiveness

Optimal Timing: When to Take Losartan for Maximum Benefit

Is there an ideal time to take losartan? For most people, the timing of losartan intake can be adjusted to fit their daily routine. However, some considerations may influence the best time for you:

1. Before bedtime: Your doctor might recommend taking the first dose before bed, as it can cause dizziness in some individuals.
2. Morning routine: Many people find it convenient to take losartan in the morning as part of their daily routine.
3. Evening schedule: Some studies suggest taking blood pressure medications in the evening may provide better 24-hour blood pressure control.

Ultimately, the best time to take losartan is the time that works consistently with your schedule, allowing you to adhere to the prescribed regimen.

Dosage Guidelines: Tailoring Losartan to Individual Needs

The appropriate dosage of losartan varies depending on the condition being treated and individual patient factors. How much losartan should you take? Here are some general guidelines:

• For high blood pressure: Adults typically start with 50mg once daily, which may be adjusted up to 100mg.
• For heart failure: The dosage range is usually 12.5mg to 150mg once daily.
• For kidney protection: Dosages are similar to those for high blood pressure treatment.

Children’s dosages are typically calculated based on body weight. It’s crucial to follow your healthcare provider’s instructions precisely and not adjust the dosage without consultation.

Managing Missed Doses and Potential Overdose Situations

Forgot to take your losartan dose? Don’t panic. If you remember within a few hours of your usual time, take the missed dose. However, if it’s almost time for your next scheduled dose, skip the missed one and continue with your regular schedule. Never double up on doses to make up for a missed one.

In case of a suspected overdose, immediate medical attention is crucial. Symptoms of losartan overdose may include:

• Dizziness
• Sleepiness
• Rapid heartbeat

If you experience these symptoms after taking more than your prescribed dose, contact your healthcare provider or seek emergency medical care promptly.

Losartan and Lifestyle: Optimizing Treatment Effectiveness

While losartan is an effective medication for managing high blood pressure, its benefits can be enhanced through lifestyle modifications. How can you maximize the effectiveness of your losartan treatment?

• Maintain a healthy diet low in sodium
• Engage in regular physical activity
• Manage stress through relaxation techniques or mindfulness practices
• Limit alcohol consumption
• Quit smoking if applicable

These lifestyle changes, when combined with proper losartan usage, can significantly improve blood pressure control and overall cardiovascular health.

Side Effects and Precautions: What to Watch For

Like all medications, losartan can cause side effects in some individuals. Common side effects may include:

• Dizziness
• Headache
• Fatigue
• Diarrhea

Most side effects are mild and tend to resolve as your body adjusts to the medication. However, certain situations require immediate medical attention. Seek help if you experience:

• Severe dizziness or fainting
• Signs of kidney problems, such as a change in urine output
• Symptoms of high potassium levels, including muscle weakness or irregular heartbeat

It’s important to inform your healthcare provider about all medications, supplements, and herbal products you’re taking, as some may interact with losartan.

Long-Term Use of Losartan: What to Expect

Losartan is often prescribed as a long-term treatment for high blood pressure. What should you expect with prolonged use? Here are some key points to consider:

• Regular monitoring: Your doctor will likely schedule periodic check-ups to assess your blood pressure and kidney function.
• Dose adjustments: Based on your response and any side effects, your dosage may be adjusted over time.
• Continued effectiveness: Losartan typically maintains its blood pressure-lowering effects with long-term use.
• Lifestyle importance: Maintaining healthy habits remains crucial for optimal results.

Remember, losartan controls high blood pressure but does not cure it. Continuing the medication as prescribed, even if you feel well, is essential for maintaining its benefits.

Special Considerations: Losartan Use in Specific Populations

Certain groups may require special attention when using losartan. How does losartan use differ for these populations?

Elderly Patients

Older adults may be more sensitive to the effects of losartan. Lower starting doses are often recommended, with careful monitoring for side effects.

Pregnant Women

Losartan is not recommended during pregnancy, especially in the second and third trimesters, due to potential risks to the developing fetus. If you become pregnant while taking losartan, contact your healthcare provider immediately.

Patients with Kidney or Liver Disease

Individuals with impaired kidney or liver function may require dose adjustments and closer monitoring when taking losartan.

Always inform your healthcare provider of any existing health conditions to ensure safe and effective use of losartan.

In conclusion, losartan is a valuable tool in the management of high blood pressure, but its effectiveness relies on proper usage and adherence to prescribed regimens. By understanding the optimal timing, dosage, and potential side effects, patients can maximize the benefits of this medication while minimizing risks. Remember, open communication with your healthcare provider is key to achieving the best outcomes in your hypertension management journey.

Losartan: medicine to treat high blood pressure

Take losartan tablets once a day.

Your doctor may suggest that you take your first dose before bedtime, because it can make you dizzy. After the very first dose, you can take losartan at any time of day. Try to take it at the same time every day.

You can take losartan tablets with or without food. Swallow the tablets with a drink of water.

How much will I take?

The dose of losartan you take depends on why you need the medicine. Take it as instructed by your doctor.

Usually, adults take:

• 50mg to 100mg once a day to treat high blood pressure and to protect their kidneys
• 12.5mg to 150mg once a day for heart failure

The dose may be lower if you’ve recently lost body fluids (for example, because of diarrhoea or being sick) or you’re over the age of 75.

If your child needs losartan, your doctor will usually use your child’s weight to work out the right dose.

Will my dose go up or down?

After a few weeks your doctor will check your blood pressure and ask you if you’re getting any side effects. You may also have blood tests to check how well your kidneys are working and the amount of potassium in your blood. Your doctor will then decide whether to change your dose of losartan.

If losartan doesn’t bring your blood pressure down, your doctor may want to increase the dose. If your blood pressure gets too low or you get side effects, your doctor may want to lower your dose.

What if I get sick while I’m taking it?

If you get severe diarrhoea or vomiting for any reason, contact your doctor or a pharmacist. They’ll be able to advise you about what to do.

They may recommend that you stop taking losartan until you’re better, and you’re able to eat and drink normally again.

What if I forget to take it?

If you miss a dose of losartan, take it as soon as you remember. Do not take a double dose to make up for a forgotten one.

If you often forget doses, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways of helping you remember your medicine.

What if I take too much?

If you take too many losartan tablets by accident, contact your doctor or go to your nearest hospital A&E department straight away.

An overdose of losartan can cause dizziness, sleepiness and a pounding heartbeat.

The amount of losartan that can lead to an overdose varies from person to person.

Losartan (Oral Route) Proper Use

Proper Use

Drug information provided by: IBM Micromedex

In addition to the use of the medicine your doctor has prescribed, treatment for your high blood pressure may include weight control and changes in the types of foods you eat, especially foods high in sodium (salt). Your doctor will tell you which of these are most important for you. You should check with your doctor before changing your diet.

Many patients who have high blood pressure will not notice any signs of the problem. In fact, many may feel normal. It is very important that you take your medicine exactly as directed and that you keep your appointments with your doctor even if you feel well.

Remember that this medicine will not cure your high blood pressure but it does help control it. You must continue to take it as directed if you expect to lower your blood pressure and keep it down. You may have to take high blood pressure medicine for the rest of your life. If high blood pressure is not treated, it can cause serious problems such as heart failure, blood vessel disease, stroke, or kidney disease.

This medicine comes with a patient information insert. Read and follow the instructions carefully. Ask your doctor if you have any questions.

This medicine may be taken with or without food.

If you are unable to swallow tablets, ask your pharmacist about preparing an oral suspension for you.

Dosing

The dose of this medicine will be different for different patients. Follow your doctor’s orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

• 
  For oral dosage form (tablets):
  • 
    For high blood pressure:
    • 
      Adults—At first, 50 milligrams (mg) once a day. Your doctor may adjust your dose as needed.
    • 
      Children 6 to 16 years of age—Dose is based on body weight and must be determined by your doctor. The starting dose is usually 0.7 milligram (mg) per kilogram (kg) of body weight per day. Your doctor may adjust your dose as needed. However, the dose is usually not more than 50 mg per day.
    • 
      Children younger than 6 years of age—Use and dose must be determined by your doctor.

  • 
    For lowering risk of stroke in patients with high blood pressure and enlargement of the heart:
    • 
      Adults—At first, 50 milligrams (mg) once a day. Your doctor may adjust your dose and add another medicine based on your blood pressure response.
    • 
      Children—Use and dose must be determined by your doctor.

  • 
    For diabetic nephropathy:
    • 
      Adults—At first, 50 milligrams (mg) once a day. Your doctor may adjust your dose based on your blood pressure response.
    • 
      Children—Use and dose must be determined by your doctor.

Missed Dose

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Portions of this document last updated: July 01, 2021

Copyright © 2021 IBM Watson Health. All rights reserved. Information is for End User’s use only and may not be sold, redistributed or otherwise used for commercial purposes.

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When to Take Losartan Morning or Night?

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A:

Losartan can be taken once or twice a day. For once daily dosing, there are no absolute recommendations about taking it in the morning vs. night. For high blood pressure, some research suggests taking medicines at night reduces the risk of cardiovascular events in the morning. Check with your doctor for questions about timing.

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About The Author

Sarah Lewis is a pharmacist and a medical writer with over 25 years of experience in various areas of pharmacy practice. Sarah holds a Bachelor of Science in Pharmacy degree from West Virginia University and a Doctor of Pharmacy degree from Massachusetts College of Pharmacy. She completed Pharmacy Practice Residency training at the University of Pittsburgh/VA Pittsburgh Healthcare System. 

Last Updated: May 12, 2020

THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.

Losartan – an angiotensin receptor blocker. Information

About losartan

Losartan is an angiotensin receptor blocker. It is also called an angiotensin-II receptor antagonist, or an AIIRA. You will have been prescribed losartan for one of the following reasons:

Losartan works by blocking the effect of a substance in your body called angiotensin II. Angiotensin II causes your blood vessels to narrow and also leads to the production of another substance called aldosterone, which increases the amount of fluid in your blood. By preventing the action of angiotensin II, losartan reduces how much work your heart has to do and lowers your blood pressure. It also has a protective effect on your kidneys.

You may be prescribed losartan to take on its own, or alongside other medicines to help your condition. There is a combination tablet available called Cozaar-Comp® which contains losartan with a diuretic called hydrochlorothiazide. This combination tablet can be prescribed to people with high blood pressure to help reduce the total number of tablets that need to be taken each day.

Before taking losartan

Some medicines are not suitable for people with certain conditions, and sometimes a medicine can only be used if extra care is taken. For these reasons, before you start taking losartan it is important that your doctor knows:

• If you are pregnant or breastfeeding.
• If you know you have a blockage of the artery which supplies blood to your kidneys, a condition called renal artery stenosis.
• If you have any problems with your heart valves or heart muscle.
• If you have a problem with the way your liver works.
• If you are taking any other medicines. This includes any medicines you are taking which are available to buy without a prescription, as well as herbal and complementary medicines.
• If you have ever had an allergic reaction to a medicine, or if you have had any other type of allergic reaction.

How to take losartan

• Before you start the treatment, read the manufacturer’s printed information leaflet from inside the pack. It will give you more information about losartan and will provide you with a full list of the side-effects which you could experience from taking it.
• Take losartan once each day, exactly as your doctor tells you to. There are several different strengths of tablet available. When you first start treatment your doctor may gradually increase the strength of the tablets to suit your condition. Each time you collect a fresh supply, it’s a good idea to check the strength on the packet to make sure they are what you are expecting.
• Try to take losartan at the same time of day each day. For most people this will be in the morning. Taking your doses at the same time each day will help you to remember to take losartan regularly.
• Swallow the tablet whole with a drink of water. You can take losartan either before or after a meal.
• If you forget to take a dose, take it as soon as you remember. If you do not remember until the following day, miss out the forgotten dose. Do not take two doses at the same time to make up for a forgotten dose.

Getting the most from your treatment

• Try to keep your regular appointments with your doctor. This is so your progress can be monitored. Your doctor may want you to have some blood tests from time to time to check on your kidneys, and also how much potassium is in your blood.
• If you buy any medicines, check with a pharmacist that they are suitable to take with losartan. This is because some anti-inflammatory painkillers (such as aspirin and ibuprofen) can interfere with the way it works, and also may increase the risk of side-effects.
• It is very important that you follow any dietary and lifestyle advice that you have been given by your doctor, such as eating a healthy diet, not smoking, and taking regular exercise.
• If you drink alcohol, ask your doctor for advice. Your doctor may recommend that you do not drink alcohol while you are on losartan because it will increase the risk of side-effects, such as feeling dizzy or faint.
• Try to avoid salt substitutes which contain potassium. This is because the substitutes will increase the amount of potassium in your blood and this can cause problems.
• If you are having an operation or dental treatment, tell the person carrying out the treatment that you are taking losartan. This is because your blood pressure may drop too low if you are given some anaesthetics.
• Treatment with losartan is usually long-term unless you experience an adverse effect. Continue to take the tablets regularly, unless you are advised otherwise by your doctor.

If you are also taking hydrochlorothiazide in combination with this medicine

• Studies have suggested that taking higher doses of hydrochlorothiazide for long periods of time may increase the risk of certain skin cancers.
• Tell your doctor if you have ever been treated for skin cancer before.
• Tell your doctor about any new or changed moles or worrying marks on your skin.
• Use a sunscreen in strong sunlight. Do not use sunbeds.

Can losartan cause problems?

Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. The table below contains some of the most common ones associated with losartan. You will find a full list in the manufacturer’s information leaflet supplied with your medicine. The unwanted effects often improve as your body adjusts to the new medicine, but speak with your doctor or pharmacist if any of the following continue or become troublesome.

If you experience any other symptoms which you think may be due to the medicine, speak with your doctor or pharmacist for further advice.

How to store losartan

• Keep all medicines out of the reach and sight of children.
• Store the tablets in a cool, dry place, away from direct heat and light.
• Store the liquid medicine in a refrigerator and do not use it after the expiry date on the bottle. The expiry date is four weeks after it has been made up by the pharmacy. 

Important information about all medicines

Losartan potassium 12.5 mg film-coated tablets – Patient Information Leaflet (PIL)

LOSARTAN POTASSIUM 12.5 mg FILM-COATED TABLETS

LOSARTAN POTASSIUM 25 mg FILM-COATED TABLETS

LOSARTAN POTASSIUM 50 mg FILM-COATED TABLETS

LOSARTAN POTASSIUM 100 mg FILM-COATED TABLETS

(losartan potassium)

• Keep this leaflet. You may need to read it again.
• If you have any further questions, ask your doctor, pharmacist or nurse.
• This medicine has been prescribed for you only. Do not pass it on to others. It may harm them, even if their signs of illness are the same as yours.
• If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in this leaflet. See section 4.

1. What Losartan Tablets are and what they are used for

2. What you need to know before you take Losartan Tablets

3. How to take Losartan Tablets

4. Possible side effects

5. How to store Losartan Tablets

6. Contents of the pack and other information

Losartan belongs to a group of medicines known as angiotensin-II receptor antagonists.

Angiotensin-II is a substance produced in the body which binds to receptors in blood vessels, causing them to tighten. This results in an increase in blood pressure. Losartan prevents the binding of angiotensin-II to these receptors, causing the blood vessels to relax which in turn lowers the blood pressure. Losartan slows the decrease of kidney function in patients with high blood pressure and type 2 diabetes.

Losartan Tablets are used

• to treat patients with high blood pressure (hypertension) in adults and in children and adolescents 6-18 years of age.
• to protect the kidney in hypertensive type 2 diabetic patients with laboratory evidence of impaired renal function and proteinuria ≥0.5 g per day (a condition in which urine contains an abnormal amount of protein).
• to treat patients with chronic heart failure when therapy with specific medicines called angiotensin-converting-enzyme inhibitors (ACE inhibitors, medicine used to lower high blood pressure) is not considered suitable by your doctor. If your heart failure has been stabilised with an ACE inhibitor you should not be switched to losartan.
• in patients with high blood pressure and a thickening of the left ventricle, Losartan Tablets have been shown to decrease the risk of stroke (“LIFE indication”).

• if you are allergic to losartan or to any of the other ingredients of this medicine (listed in section 6),
• if you are more than 3 months pregnant. (It is better to avoid Losartan Tablets in early pregnancy – see Pregnancy),
• if your liver function is severely impaired,

• if you have diabetes or impaired kidney function and you are treated with a blood pressure lowering medicine containing aliskiren,

Talk to your doctor, pharmacist or nurse before taking Losartan Tablets.

You must tell your doctor if you think you are (or might become) pregnant. Losartan Tablets are not recommended in early pregnancy, and must not be taken if you are more than 3 months pregnant, as it may cause serious harm to your baby if used at that stage (see pregnancy section).

It is important to tell your doctor before taking Losartan Tablets:

• if you have had a history of angioedema (swelling of the face, lips, throat, and/or tongue) (see also section 4 ‘Possible side effects’),
• if you suffer from excessive vomiting or diarrhoea leading to an extreme loss of fluid and/or salt in your body,
• if you receive diuretics (medicines that increase the amount of water that you pass out through your kidneys) or are under dietary salt restriction leading to an extreme loss of fluid and salt in your body (see section 3 ‘Dosage in special patient groups’),
• if you are known to have narrowing or blockage of the blood vessels leading to your kidneys or if you have received a kidney transplant recently,
• if your liver function is impaired (see sections 2 “Do not take Losartan Tablets” and 3 “Dosage in special patient groups“),
• if you suffer from heart failure with or without renal impairment or concomitant severe life threatening cardiac arrhythmias. Special caution is necessary when you are treated with a ß-blocker concomitantly,
• if you have problems with your heart valves or heart muscle,
• if you suffer from coronary heart disease (caused by a reduced blood flow in the blood vessels of the heart) or from cerebrovascular disease (caused by a reduced blood circulation in the brain),
• if you suffer from primary hyperaldosteronism (a syndrome associated with increased secretion of the hormone aldosterone by the adrenal gland, caused by an abnormality within the gland),
• if you are taking any of the following medicines used to treat high blood pressure:
  • an ACE-inhibitor (for example enalapril, lisinopril, ramipril), in particular if you have diabetes-related kidney problems.
  • aliskiren

Your doctor may check your kidney function, blood pressure, and the amount of electrolytes (e.g. potassium) in your blood at regular intervals.

See also information under the heading “Do not take Losartan Tablets“.

• If you are taking other medications that may increase serum potassium (see section 2 “Other medicines and Losartan Tablets)

Losartan has been studied in children. For more information, talk to your doctor. Losartan Tablets are not recommended for use in children suffering from kidney or liver problems, as limited data are available in these patient groups. Losartan Tablets are not recommended for use in children under 6 years old, as it has not been shown to work in this age group.

Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines.

Tell your doctor if you are taking potassium supplements, potassium-containing salt substitutes, potassium-sparing medicines such as certain diuretics (amiloride, triamteren, spironolactone), or other medicines that may increase serum potassium (e.g., heparin, trimethoprim-containing medicines), as the combination with Losartan is not advisable.

Take particular care if you are taking the following medicines while under treatment with Losartan Tablets:

• other blood pressure lowering medicines as they may additionally reduce your blood pressure.
  
  Blood pressure may also be lowered by one of the following drugs/ class of drugs: tricyclic antidepressants, antipsychotics, baclofene, amifostine,
• non-steroidal anti-inflammatory drugs such as indomethacin, including Cox-2-inhibitors (medicines that reduce inflammation, and can be used to help relieve pain) as they may reduce the blood pressure lowering effect of losartan.

Your doctor may need to change your dose and/or to take other precautions:

• if you are taking an ACE-inhibitor or aliskiren (see also information under the headings “Do not take Losartan Tablets” and “Warnings and precautions“.

If your kidney function is impaired, the concomitant use of these medicines may lead to a worsening of the kidney function.

Lithium containing medicines should not be taken in combination with losartan without close supervision by your doctor. Special precautionary measures (e.g. blood tests) may be appropriate.

Losartan Tablets may be taken with or without food.

Pregnancy

You must tell your doctor if you think you are (or might become) pregnant. Your doctor will normally advise you to stop taking Losartan Tablets before you become pregnant or as soon as you know you are pregnant and will advise you to take another medicine instead of Losartan Tablets.

Losartan Tablets are not recommended in early pregnancy, and must not be taken when more than 3 months pregnant, as it may cause serious harm to your baby if used after the third month of pregnancy.

Breast-feeding

Tell your doctor if you are breast-feeding or about to start breast-feeding. Losartan Tablets are not recommended for mothers who are breast-feeding, and your doctor may choose another treatment for you if you wish to breast-feed, especially if your baby is new-born, or born prematurely.

Ask your doctor or pharmacist for advice before taking this medicine.

No studies on the effects on the ability to drive and use machines have been performed.

Losartan Tablets are unlikely to affect your ability to drive or use machines. However, as with many other medicines used to treat high blood pressure, losartan may cause dizziness or drowsiness in some people. If you experience dizziness or drowsiness, you should consult your doctor before attempting such activities.

Losartan Tablets contain lactose monohydrate. If you have been told by your doctor that you have an intolerance to some sugars, contact your doctor before taking this medicine.

Always take Losartan Tablets exactly as your doctor or pharmacist has told you. Check with your doctor or pharmacist if you are not sure. Your doctor will decide on the appropriate dose of Losartan Tablets, depending on your condition and whether you are taking other medicines. It is important to continue taking Losartan Tablets for as long as your doctor prescribes it in order to maintain smooth control of your blood pressure.

Adult patients with High Blood Pressure

Treatment usually starts with 50 mg losartan (one tablet Losartan 50 mg) once a day. The maximal blood pressure lowering effect should be reached 3-6 weeks after beginning treatment. In some patients the dose may later be increased to 100 mg losartan once daily (two tablets Losartan 50 mg or one tablet of Losartan 100 mg) once daily.

If you have the impression that the effect of losartan is too strong or too weak, please talk to your doctor or pharmacist.

Children below 6 years of age

Losartan Tablets are not recommended for use in children under 6 years old as it has not been shown to work in this age group.

Children aged 6 to 18 years old

The recommended starting dose in patients who weigh between 20 and 50 kg is 0.7 mg of losartan per kg of body weight administered once a day (up to 25 mg of Losartan Tablets). The doctor may increase the dose if blood pressure is not controlled.

Adult patients with high blood pressure and type 2 diabetes

Treatment usually starts with 50 mg losartan (one tablet Losartan 50 mg) once a day. The dose may later be increased to 100 mg losartan (two tablets Losartan 50 mg or one tablet of Losartan 100 mg) once daily depending on your blood pressure response.

Losartan tablets may be administered with other blood pressure lowering medicines (e.g. diuretics, calcium channel blockers, alpha- or beta-blockers, and centrally acting agents) as well as with insulin and other commonly used medicines that decrease the level of glucose in the blood (e.g. sulfonylureas, glitazones and glucosidase inhibitors).

Adult patients with Heart Failure

Treatment usually starts with 12.5 mg losartan (one tablet Losartan 12.5 mg) once a day. Generally, the dose should be increased weekly step-by-step (i.e., 12.5 mg daily during the first week, 25 mg daily during the second week, 50 mg daily during the third week, 100 mg daily during the fourth week, 150 mg daily during the fifth week) up to the maintenance dose as determined by your physician.

A maximum dose of 150 mg losartan (for example, three tablets of Losartan 50 mg or one tablet each of Losartan 100 mg and Losartan 50 mg) once daily may be used.

In the treatment of heart failure, losartan is usually combined with a diuretic (medicine that increases the amount of water that you pass out through your kidneys) and/or digitalis (medicine that helps to make the heart stronger and more efficient) and/ or a beta-blocker.

The doctor may advise a lower dose, especially when starting treatment in certain patients such as those treated with diuretics in high doses, in patients with liver impairment, or in patients over the age of 75 years. The use of losartan is not recommended in patients with severe hepatic impairment (see section “Do not take Losartan Tablets”).

The tablets should be swallowed with a glass of water. You should try to take your daily dose at about the same time each day.

It is important that you continue to take Losartan Tablets until your doctor tells you otherwise.

If you accidentally take too many tablets, or a child swallows some, contact your doctor immediately.

Symptoms of overdose are low blood pressure, increased heartbeat, possibly decreased heartbeat.

If you accidentally miss a daily dose, just take the next dose as normal. Do not take a double dose to make up for a forgotten tablet. If you have any further questions on the use of this medicine, ask your doctor, pharmacist or nurse.

Like all medicines, Losartan Tablets can cause side effects, although not everybody gets them.

If you experience the following, stop taking losartan tablets and tell your doctor immediately or go to the casualty department of your nearest hospital:

A severe allergic reaction (rash, itching, swelling of the face, lips, mouth or throat that may cause difficulty in swallowing or breathing).

This is a serious but rare side effect, which affects more than 1 out of 10,000 patients but fewer than 1 out of 1,000 patients. You may need urgent medical attention or hospitalisation.

The following side effects have been reported with losartan:

Common (may affect up to 1 in 10 people):

• dizziness,
• low blood pressure (especially after excessive loss of water from the body within blood vessels e. g. in patients with severe heart failure or under treatment with high dose diuretics),
• dose-related orthostatic effects such as lowering of blood pressure appearing when rising from a lying or sitting position,
• vertigo,
• debility,
• fatigue,
• too little sugar in the blood (hypoglycaemia),
• too much potassium in the blood (hyperkalaemia),
• changes in kidney function including kidney failure,
• reduced number of red blood cells (anaemia),
• increase in blood urea, serum creatinine and serum potassium in patients with heart failure,

Uncommon (may affect up to 1 in 100 people):

• somnolence,
• headache,
• sleep disorders,
• feeling of increased heart rate (palpitations),
• severe chest pain (angina pectoris),
• shortness of breath (dyspnoea),
• abdominal pain,
• severe constipation,
• diarrhoea,
• nausea,
• vomiting,
• hives (urticaria),
• itching (pruritus),
• rash,
• localised swelling (oedema),
• cough.

Rare (may affect up to 1 per 1,000 people):

• hypersensitivity reactions,
• angioedema,
• inflammation of blood vessels (vasculitis including Henoch-Schonlein purpura),
• numbness or tingling sensation (paraesthesia),
• fainting (syncope),
• very rapid and irregular heartbeat (atrial fibrillation),
• brain attack (stroke),
• inflammation of the liver (hepatitis),
• elevated blood alanine aminotransferase (ALT) levels, usually resolved upon discontinuation of treatment.

Not known (frequency cannot be estimated from the available data):

• reduced number of thrombocytes,
• migraine,
• liver function abnormalities,
• muscle and joint pain,
• flu-like symptoms,
• back pain and urinary tract infection,
• increased sensitivity to the sun (photosensitivity),
• unexplained muscle pain with dark (tea-coloured) urine (rhabdomyolysis),
• impotence,
• inflammation of the pancreas (pancreatitis),
• low levels of sodium in the blood (hyponatraemia),
• depression,
• generally feeling unwell (malaise),
• ringing, buzzing, roaring, or clicking in the ears (tinitus),
• distorted sense of taste (dysgeusia).

Side effects in children are similar to those in adults.

If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in this leaflet.

If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the Yellow Card Scheme at www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store. By reporting side effects you can help provide more information on the safety of this medicine.

Keep this medicine out of the reach and sight of children.

Do not use Losartan Tablets after the expiry date which is stated on the carton after Exp. The expiry date refers to the last day of that month.

Do not store Losartan Tablets above 25°C. Store Losartan Tablets in the original package. Do not open the blister pack until you are ready to take the medicine.

Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to throw away medicines you no longer use. These measures will help to protect the environment.

The active substance is losartan potassium.

Each Losartan potassium 12.5 mg Tablet contains 12.5 mg of losartan potassium.

Each Losartan potassium 25 mg Tablet contains 25 mg of losartan potassium.

Each Losartan potassium 50 mg Tablet contains 50 mg of losartan potassium.

Each Losartan potassium 100 mg Tablet contains 100 mg of losartan potassium.

The other ingredients are lactose monohydrate, starch pregelatinised, colloidal anhydrous silica, microcrystalline cellulose, magnesium stearate, carnauba wax, hypromellose, titanium dioxide (E171) and macrogol 400.

Losartan potassium 12.5 mg, 25 mg, 50 mg and 100 mg Tablets contain potassium in the following amounts: 1.06 mg (0.027 mEq), 2.12 mg (0.054 mEq), 4.24 mg (0.108 mEq) and 8.48 mg (0.217 mEq) respectively.

Losartan potassium 12.5 mg Tablets are supplied as a white, film-coated round, biconvex tablet.

Losartan potassium 12.5 mg Tablets come in calendar packs of 28 tablets.

Losartan potassium 25mg Tablets are supplied as white, film-coated, round, biconvex tablets, scored on both sides. Losartan potassium 25 mg Tablets come in calendar packs of 28 tablets.

Losartan potassium 50mg Tablets are supplied as white, film-coated, round, biconvex tablets, quadrisected on one side.

Losartan potassium 50 mg Tablets come in calendar packs of 28 tablets.

Losartan potassium 100mg Tablets are supplied as white, film-coated, oblong, biconvex tablets, scored on both sides. Losartan potassium 100 mg Tablets come in calendar packs of 28 tablets.

Not all pack sizes may be marketed.

Dexcel^® – Pharma Ltd.
7 Sopwith Way
Drayton Fields
Daventry
Northamptonshire
NN11 8PB
UK

This leaflet was last revised in July 2019.

Losartan | Health Navigator NZ

Losartan is used to treat high blood pressure and heart failure and to prevent kidney problems in people with diabetes. Find out how to take it safely and possible side effects. Losartan is also called Cozaar.

What is losartan?

Losartan has many different effects on the body and is used to treat a variety of conditions. It belongs to a group of medicines called ARBs. Losartan may be used for:

• high blood pressure (hypertension) by relaxing the blood vessels and lowering your blood pressure
• heart failure to help your heart pump blood more easily. This can help to relieve symptoms such as shortness of breath and swelling of feet, legs and abdomen
• diabetic kidney disease (diabetic nephropathy) to protect your kidneys and help them to function.

Losartan can work quickly for high blood pressure (hypertension). If you have heart failure it may be a few weeks before you notice an improvement in your symptoms. Once you have started losartan you will generally keep taking it for life unless you have a side effect. In New Zealand losartan is available as tablets.

Dose

Losartan tablets come in different strengths: 12.5 mg, 25 mg, 50 mg and 100 mg.

• The dose of losartan will be different for different people. Your doctor will tell you the dose that is right for you. Your dose of losartan will depend on what it is being used for.
• Your doctor will usually start you on a low dose, and increase the dose depending on how you respond. This allows your body to get used to the medicine and reduces unwanted side effects.
• Losartan is usually taken once a day.
• Always take your losartan exactly as your doctor has told you. The pharmacy label on your medicine will tell you how much losartan to take, how often to take it, and any special instructions.
• Losartan tablets are available in different strengths. If your tablets look different to your last supply speak with your doctor or pharmacist for advice.

How to take losartan

• Timing: Take losartan, once a day, at the same time each day. It is best taken in the morning. You can take losartan with or without food.
• Limit drinking alcohol while you are taking losartan. Alcohol can increase your chance of side effects such as dizziness and lightheadedness.
• Missed dose: If you forget to take your dose, take it as soon as you remember that day. But, if it is nearly time for your next dose, just take the next dose at the right time. Do not take double the dose..

Precautions – before taking losartan

• Are you pregnant or planning a pregnancy?
• Are you breastfeeding?
• Do you have problems with your kidneys or liver?
• Have you ever had an allergic reaction with swelling of your lips, eyes or tongue (called angioedema)?
• Are you are taking or using any other medicines? This includes any medicines you are using which are available to buy from a pharmacy, supermarket or natural health store without a prescription.

If so, it’s important that you tell your doctor or pharmacist before you start taking losartan. Sometimes a medicine isn’t suitable for a person with certain conditions, or it can only be used with extra care.

Cautions while you are taking losartan

Have a sick day plan

If you have diarrhoea or are vomiting from a stomach bug, or have dehydration from other causes, it’s important to let your doctor know, as they may advise you to stop taking your losartan for a few days and restart when you feel better. The reason for this is that losartan can increase the amount of potassium salts in your blood, particularly if you are dehydrated.

Be careful when taking some pain relief medicines

Losartan help to protect your kidneys from damage if you have diabetes. In most cases losartan is protective but if you are taking losartan and diuretics (water pills), the combination of these with NSAIDs (anti-inflammatory pain relief medication) can be very harmful to your kidneys. It can cause acute kidney injury. This combination is called the dangerous trio or triple whammy. You have a higher risk of harm to your kidneys if you are also elderly or are dehydrated. 

If you are taking losartan with a diuretic, do not use NSAIDs for pain relief. Ask your doctor or pharmacist for a safer option. Read more about NSAIDs and protecting your kidneys.

Side effects

Like all medicines, losartan can cause side effects, although not everyone gets them. Often side effects improve as your body gets used to the new medicine.

Interactions

• Losartan may interact with a few medications and herbal supplements so check with your doctor or pharmacist before starting losartan or before starting any new medicines.
• Also, check with your pharmacist before taking over-the-counter medicines such as anti-inflammatories such as diclofenac (e.g. Voltaren Rapid), ibuprofen (e.g. Nurofen), naproxen (e.g. Naprogesic).

Learn more

The following links have more information on losartan:

New Zealand Formulary Patient Information: losartan

References

1. Losartan New Zealand Formulary

Losartan: What Is the Right Dosage for Me?

If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.

Medications and dosages aren’t really a one-size-fits-all kind of thing. But when it comes to finding the right dosage, it’s not always as easy as trying on shoes. Sometimes it can take time and multiple-dose adjustments by your healthcare provider to reach the dosing schedule that’s right for you. If you’re just starting treatment with losartan or recently had your dosage adjusted, here’s what you need to know.

• Losartan is a medication used to treat high blood pressure, reduce the risk of stroke, and reduce kidney damage in people with diabetes. 
• The standard starting dose for losartan is 50 mg.
• Smaller starting doses of 25 mg are used in patients with certain health conditions, and higher doses are sometimes used if standard doses aren’t enough to control your symptoms.

The standard starting dose for adults taking losartan is a 50 mg tablet, taken once a day by mouth. Losartan is approved by the U.S. Food and Drug Administration (FDA) to treat high blood pressure, reduce the risk of stroke in patients with high blood pressure, and manage kidney problems associated with diabetes (diabetic nephropathy).  

The suggested starting dose for the treatment of any of these conditions is the same. Those being treated for high blood pressure with left ventricular hypertrophy may be prescribed losartan as well as a diuretic such as hydrochlorothiazide as an additional treatment (FDA, 2018).

Your healthcare provider may start you on a lower dose if you have certain health conditions. This lower dose is typically 25 mg, taken once daily. Those who may get a lower starting dose of losartan include those with liver problems, older adults, and individuals who are also taking diuretics (“water pills”) (FDA, 2018).

If you start on a dosage of 50 mg, you may have your dosage increased if 50 mg of losartan is not enough to adequately lower your blood pressure to within a healthy range. If this is the case, your dosage may be increased from 50 mg to 100 mg, taken once daily. 

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Doses may be increased up to a maximum of 100 mg in adults with high blood pressure or kidney problems caused by diabetes. For those with high blood pressure and left ventricular hypertrophy receiving a diuretic medication as well, your healthcare provider may increase the dosage of both medications if they see fit (FDA, 2018). In some cases, your healthcare provider may recommend that you take the medication twice daily (Szauder, 2015). 

Losartan tablets should be stored at room temperature, out of the reach of children. In the case of a missed dose, the medication should be taken as soon as you remember unless it’s almost time for your next dose. If that’s the case, simply take the next dose as scheduled. Losartan may be taken with or without food (FDA, 2018).

Losartan belongs to a drug class called angiotensin receptor blockers (ARBs) that also includes the medications valsartan and irbesartan. ARBs are generally used to treat high blood pressure, though they may be used for other conditions too. Losartan is also approved by the U.S. Food and Drug Administration (FDA) to reduce the risk of stroke and reduce the risk of kidney problems in people with diabetes (DailyMed, 2020).

Losartan may also be used off-label after a heart attack to improve symptoms of heart failure in people who have unfavorable reactions to the first-line treatment, ACE inhibitors. Also, ARBs can be used to treat non-diabetic kidney disease (UpToDate, n.d.). Losartan is available both as generic losartan potassium tablets and under the brand name Cozaar. 

ARBs lower blood pressure by blocking the actions of a hormone called angiotensin II that’s naturally produced by the body (Burnier, 2001). This hormone causes blood vessels to constrict, and too much of it may lead to high blood pressure over time. These prescription drugs relax the blood vessels, making them wider, and reducing blood pressure (DailyMed, 2020). 

The most common side effects of losartan include dizziness, stuffy nose, back pain, chest pain, diarrhea, high blood potassium levels, low blood pressure, low blood sugar, and tiredness (FDA, 2018).  

Serious side effects are possible with losartan and may include severe allergic reaction—which can present with hives, itching, rash, and trouble breathing dangerously low blood pressure (hypotension), very high blood potassium (hyperkalemia), which can cause heart problems, and changes in kidney function that may include kidney failure (DailyMed, 2020).

Since high blood levels of potassium can be dangerous, you may need to avoid high-potassium foods when taking ARBs. Past research suggests that consuming foods high in potassium may be safe for people with proper kidney function (Malta, 2016). 

But for those taking ARBs such as losartan who already have kidney problems such as chronic kidney disease (CKD) may need to limit high-potassium foods such as potatoes, tomatoes, oranges, and bananas (Han, 2013). Salt substitutes that use potassium chloride and any dietary supplements or multivitamins that contain potassium should also be avoided. 

Your healthcare provider may monitor your serum potassium levels using a simple blood test to determine if you need to be careful about your potassium intake.

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Losartan may also cause serious adverse effects when combined with certain medications. Drug interactions may occur if this prescription medicine is mixed with lithium, non-steroidal anti-inflammatory drugs (NSAIDs) (such as ibuprofen and naproxen), ACE inhibitors, and aliskiren, a different type of medication that’s also used to lower blood pressure (DailyMed, 2020). 

You should stop taking losartan if you become pregnant as the drug may cause fetal injury or even death if taken during the final six months (second and third trimester) of pregnancy. You should not breastfeed when taking losartan as the medication may pass into the breast milk (FDA, 2018). 

Tell your healthcare provider or pharmacist about what other drugs or supplements you’re taking before starting treatment with losartan. If you need to undergo surgery, make sure to tell your healthcare provider about any medications you are taking. The combination of losartan and the medications used for surgical anesthesia may put you at an increased risk of dangerously low blood pressure (hypotension) (Bertrand, 2001).

1. Bertrand, M., Godet, G., Meersschaert, K., Brun, L., Salcedo, E., & Coriat, P. (2001). Should the Angiotensin II Antagonists be Discontinued Before Surgery? Anesthesia and Analgesia, 92(1), 26-30. doi:10.1097/00000539-200101000-00006. Retrieved from https://pubmed.ncbi.nlm.nih.gov/11133595/
2. Burnier, M. (2001). Angiotensin II Type 1 Receptor Blockers. Circulation, 103(6), 904-912. doi:10.1161/01.cir.103.6.904. Retrieved from https://www.ahajournals.org/doi/10.1161/01.cir.103.6.904
3. DailyMed – Losartan Potassium tablets 25 mg, film coated (2020). Retrieved on 2 September 2020 from https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=a3f034a4-c65b-4f53-9f2e-fef80c260b84
4. Food and Drug Administration (FDA). (2018, October). Cozaar (losartan potassium) label. Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/020386s062lbl.pdf
5. Han, H. (2013). Blood pressure medications: ACE-I/ARB and chronic kidney disease. Journal of Renal Nutrition, 23, e105–e107. Retrieved from https://www.jrnjournal.org/article/S1051-2276%2813%2900152-0/pdf
6. Malta, D., Arcand, J., Ravindran, A., Floras, V., Allard, J. P., & Newton, G. E. (2016). Adequate intake of potassium does not cause hyperkalemia in hypertensive individuals taking medications that antagonize the renin angiotensin aldosterone system. The American Journal of Clinical Nutrition, 104(4), 990-994. doi:10.3945/ajcn.115.129635. Retrieved from https://academic.oup.com/ajcn/article/104/4/990/4557116
7. Szauder, I., Csajági, E., Major, Z., Pavlik, G., & Ujhelyi, G. (2015). Treatment of Hypertension: Favourable Effect of the Twice-Daily Compared to the Once-Daily (Evening) Administration of Perindopril and Losartan. Kidney and Blood Pressure Research, 40(4), 374-385. doi:10.1159/000368513. Retrieved from https://www.karger.com/Article/Fulltext/368513#

See more

90,000 What they are treating us: Lozap vs hypertension

Two reviewers analyzed all the papers independently and then compared their results. Here’s what they did: None of the nine angiotensin II blockers included in the 46 studies reviewed, which were conducted in more than 13,000 patients in total, were better than the others. At the same time, doses of ¼ and 1/8 of the maximum recommended by the manufacturer were effective by 60-70% of the maximum dosage, but a certain excess of the dosage did not help to lower the pressure even more.

The authors concluded that it is possible that patients could take less drugs, which would also reduce side effects. The latter, by the way, were hardly observed. But a conflict of interest may be involved: many of the clinical trials included in the review were funded by drug manufacturers, who, of course, benefit from positive results. In addition, the studies were conducted over a couple of months, while people with hypertension sometimes have to take losartan for their entire lives, so the conclusions of this review cannot be called exhaustive.

Scientists did not stop there and found out how losartan and its antiangiotensin brother help people with heart failure if this medicine is taken for two years. This review included studies on more than 25 thousand patients – and this is only from 2002 to 2010. However, taking such drugs did not reduce the risk of becoming disabled, going to the hospital or the overall mortality of patients.

Indicator.Ru recommends: take to lower blood pressure

Lozap and its analogues with the same active ingredient (losartan) in a relatively simple scheme cause vasodilation.Our blood vessels are like a busy highway: if we widen the road, the “pressure” of the cars going will decrease and the blood pressure will decrease. There is nothing strange in the fact that Lozap, which dilates blood vessels, helps with high blood pressure. In addition, it is quite specific and does its job without intruding too much into the routine of heart contractions and other complex mechanisms that regulate blood flow.

Discontinuation of blood pressure medications in the elderly

Target

The purpose of this review is to find out if it is possible to stop taking blood pressure medications in the elderly.We also wanted to know about the consequences of stopping these drugs.

We included adults age 50 and older taking blood pressure medications to treat high blood pressure (hypertension) or to prevent cardiovascular disease (primary prevention). We excluded studies with patients with a history of myocardial infarction, stroke, or other cardiovascular disease (secondary prevention).

We compared discontinuation or dose reduction of blood pressure medications with continuing to take blood pressure medications.

Relevance

High blood pressure, also known as arterial hypertension, is a risk factor for many diseases such as myocardial infarction, renal failure and stroke. Although hypertension usually does not show any symptoms, maintaining blood pressure control is vital to stay healthy and reduce the risk of serious illness.

Hypertension is often treated with lifestyle changes and high blood pressure medications (antihypertensive drugs).There are many different types of blood pressure medications.

Antihypertensive drugs can cause dangerous side effects, such as dizziness and fatigue, which can lead to falls. Older people are at greater risk of side effects of drug treatment than younger people. It is unclear whether the benefits of antihypertensive drugs outweigh the harm they cause to older people.

Characteristics of research

Our search as of April 2019 found six studies with a total of 1073 older adults.The average age of the people who participated in the studies ranged from 58 to 82 years. In three studies, the dose of the antihypertensive drug was slowly tapered before discontinuation.

Key Outcomes

We have found that discontinuation of antihypertensive drugs is possible in older adults. Most older people in the drug discontinuation groups did not need to take them again.

We found low-certainty evidence that stopping antihypertensive drugs did not significantly increase blood pressure.

We found low or very low certainty evidence that stopping blood pressure medications did not increase the risk of myocardial infarction, stroke, hospitalization, or death.

We found very low certainty evidence that stopping blood pressure medications did not increase the risk of adverse events and could eliminate side effects, but this was not reported fully enough to draw conclusions.

None of the studies reported whether stopping blood pressure medications affected the rate of falls.

Certainty
proof

We assessed the certainty of the evidence at four levels: very low, low, medium and high. The high certainty of the evidence means we are very confident in the results. Very low certainty of evidence means that there is a high degree of uncertainty about the results.We rated the certainty of the evidence as very low.

Conclusions

It is possible that the abolition of antihypertensive drugs in the elderly, taking them “for high blood pressure” or primary prevention of cardiovascular disease, is safe.

Elderly people should not stop taking medication without consulting a healthcare professional.

Future studies should include older adults who are taking a variety of other medications and / or living with senile asthenia (weakness) syndrome.

Memorial Sloan Kettering Cancer Center

This document, provided by Lexicomp ^® , contains all the information you need to know about the drug, including the indications, route of administration, side effects and when you should contact your healthcare provider.

Trade names: USA

Cozaar

Trade names: Canada

ACT Losartan [DSC]; AG-Losartan; APO-Losartan; Auro-Losartan; BIO-Losartan; Cozaar; JAMP-Losartan; MINT-Losartan; MYLAN-Losartan [DSC]; PMS-Losartan; Priva-Losartan; RAN-Losartan; SANDOZ Losartan; Septa-Losartan; TEVA-Losartan; VAN-Losartan [DSC]

Warning

• Not for use by pregnant women.The use of the drug during pregnancy can cause birth defects or intrauterine death of the child. If you become pregnant or plan to become pregnant while taking this drug, call your doctor right away.

What is this drug used for?

• Used to treat high blood pressure.
• Used to protect kidney function in diabetic patients with low protein levels.
• This drug is used to reduce the likelihood of stroke in people with high blood pressure and heart conditions such as left ventricular hypertrophy.This drug may not reduce the likelihood of stroke in black patients with these conditions.
• This medicinal product can be used for other indications. Consult your doctor.

What do I need to tell my doctor BEFORE taking this drug?

For all patients taking this drug:

• If you are allergic to this drug, any of its ingredients, other drugs, foods or substances.Tell your doctor about your allergy and how it manifested itself.
• if you have kidney disease.
• If you are taking a drug that contains aliskiren if you have diabetes or kidney disease.

Children:

• If your child is less than 6 years old. Do not give this drug to children younger than 6 years old.

This list of drugs and diseases that may be adversely associated with this drug is not exhaustive.

Tell your doctor and pharmacist about all medicines you take (both prescription and over-the-counter, natural products and vitamins) and your health problems. You need to make sure that this drug is safe for your medical conditions and in combination with other drugs you are already taking. Do not start or stop taking any drug or change the dosage without your doctor’s approval.

What do I need to know or do while taking this drug?

• Tell all healthcare providers that you are taking this drug. These are doctors, nurses, pharmacists and dentists.
• Avoid driving vehicles and other activities that require increased attention until you see how this drug affects you.
• To reduce the risk of dizziness or loss of consciousness, get up slowly from a lying or sitting position.Use caution when going up and down stairs.
• Check blood pressure as directed.
• Perform blood tests as directed by your doctor. Please consult your doctor.
• If you are using a salt substitute containing potassium, a potassium-sparing diuretic, or a potassium supplement, consult your doctor.
• Consult your doctor if you are on a salt-free or low-salt diet.
• If you are taking this drug and have high blood pressure, talk to your doctor before taking any over-the-counter drugs that can raise blood pressure. These drugs include medicines for coughs and colds, diet pills, stimulants, nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen, and some naturally occurring drugs.
• Consult a physician before drinking alcohol.
• Exercise caution in hot weather and during vigorous activity. Drink plenty of fluids to prevent dehydration.
• Tell your doctor if you experience excessive sweating, fluid loss, vomiting, or loose stools. This can lead to a drop in blood pressure.
• Tell your doctor if you are breastfeeding. It is necessary to consult if the drug poses any risk to the child.

What side effects should I report to my doctor immediately?

WARNING. In rare cases, some people with this drug can cause serious and sometimes deadly side effects. Call your doctor or doctor right away if you have any of the following signs or symptoms, which may be associated with serious side effects:

• Signs of an allergic reaction such as rash, hives, itching, reddened and swollen skin with blistering or scaling, possibly associated with fever, wheezing or wheezing, tightness in the chest or throat, difficulty breathing, swallowing or speaking, unusual hoarseness, swelling in the mouth, face, lips, tongue, or throat.
• Signs of kidney problems, including lack of urination, change in urine volume, blood in the urine, or rapid weight gain.
• Signs of elevated potassium levels such as a feeling of a disturbed heartbeat, confusion, feeling weak or dizzy, feeling light-headed, feeling numb or tingling, or shortness of breath.
• Symptoms of low blood sugar such as dizziness, headache, drowsiness, feeling weak, trembling, tachycardia, confusion, hunger, or sweating.
• Severe dizziness or fainting.
• Chest pain.
• Swelling of the hands or feet.

What are some other side effects of this drug?

Any medicine can have side effects. However, many people have little or no side effects. Call your doctor or get medical help if these or any other side effects bother you or do not go away:

• Signs of a cold.
• Feeling dizzy, tired, or weak.
• Diarrhea.
• Back pain.
• stuffy nose.

This list of potential side effects is not comprehensive. If you have any questions about side effects, please contact your doctor. Talk to your doctor about side effects.

You can report side effects to the National Health Office.

You can report side effects to the FDA at 1-800-332-1088.You can also report side effects at https://www.fda.gov/medwatch.

What is the best way to take this drug?

Use this drug as directed by your healthcare practitioner. Read all the information provided to you. Follow all instructions strictly.

• Take this medication with or without food.
• Continue taking this drug as directed by your doctor or other healthcare professional, even if you feel well.
• If you cannot swallow the tablets, a liquid form of the drug (suspension) can be made. Ask your doctor or pharmacist for advice.
• Shake the solution (suspension) well before use.
• Doses of liquid preparation should be measured with caution. Use the dispenser that comes with the medicine. If a dispenser is not included in the package, ask your pharmacist for a dosing product for this drug.

What should I do if a dose of a drug is missed?

• Take the missed dose as soon as you can.
• If it is time for your next dose, do not take the missed dose and then return to your normal dose.
• Do not take 2 doses at the same time or an additional dose.

How do I store and / or discard this drug?

• Store at room temperature, protected from light. Store in a dry place. Do not store in the bathroom.
• The lid must be tightly closed.
• In case of dissolution (suspension) of tablets of the drug, the solution (suspension) should be stored in the refrigerator.Do not freeze. Throw away any unused portions after 28 days.
• Store all medicines in a safe place. Keep all medicines out of the reach of children and pets.
• Dispose of unused or expired drugs. Do not empty into toilet or drain unless directed to do so. If you have any questions about the disposal of your medicinal products, consult your pharmacist.Your area may have drug recycling programs.

General information on medicinal products

• If your health does not improve or even worsens, see your doctor.
• You should not give your medicine to anyone and take other people’s medicines.
• Some medicines may come with other patient information sheets. If you have questions about this drug, talk with your doctor, nurse, pharmacist, or other healthcare professional.
• Some medicines may come with other patient information sheets. Check with your pharmacist. If you have questions about this drug, talk with your doctor, nurse, pharmacist, or other healthcare professional.
• If you think an overdose has occurred, call a Poison Control Center immediately or seek medical attention. Be prepared to tell or show which drug you took, how much and when it happened.

Use of information by consumer and limitation of liability

This information should not be used to make decisions about taking this or any other drug. Only the attending physician has the necessary knowledge and experience to make decisions about which drugs are appropriate for a particular patient. This information does not guarantee that the drug is safe, effective, or approved for the treatment of any disease or specific patient.Here are only brief general information about this drug. It does NOT contain all available information on the possible use of the drug with instructions for use, warnings, precautions, information about interactions, side effects and risks that may be associated with this drug. This information should not be construed as a guide to treatment and does not replace the information provided to you by your healthcare professional. Check with your doctor for complete information on the possible risks and benefits of taking this drug.Use of this information is governed by the Lexicomp End User License Agreement available at https://www.wolterskluwer.com/en/solutions/lexicomp/about/eula.

Copyright

© UpToDate, Inc. and its affiliates and / or licensors, 2021. All rights reserved.

90,000 When is the best time to take pressure pills

Scientists note the importance of daily blood pressure measurements
Photo: pixabaycom

Comparing morning and evening medication intake, scientists have come to an unambiguous conclusion.

Many high blood pressure patients are prescribed to take one tablet a day to maintain a healthy condition. Most do this in the morning, but a recent study by the University of Vigo in Spain found this to be a mistake. The results of scientific work are published on the website of the European Heart Journal.

More than 19 thousand volunteers from 47 to 74 years old took part in the study. They were divided into two groups: the first took medications to reduce blood pressure in the morning, and the second in the evening. On a daily basis, the participants measured their blood pressure and provided the data to the scientists. The duration of the study was six years.

As a result, the researchers found that those who took the pills at night had lower blood pressure not only at night, but during the day. The fact is that during sleep, blood pressure tends to decrease, and the effect of the drug enhances the effect so much that it did not reach critical conditions even during the day.

In addition, it was noted that such a method can reduce the risk of cardiovascular diseases in half in the long term compared to those who took the medicine in the morning.

As reported by “Kubanskie Novosti”, a German nutritionist told how to reduce the content of substances hazardous to health in rice.

A doctor from India told how to get rid of bad breath.

90,000 what to take from high blood pressure pills

what to take from high blood pressure pills

The product perfectly relieves fatigue and soothes.The course of admission has no restrictions. After several months, health is fully restored and the patient feels young. Taking the drug helps prevent the occurrence of ischemic complications. Unlike the medicine that is used for chronic heart problems, it can be used for any kind of disease.

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How to choose pills for high blood pressure.Firstly, you cannot choose drugs on your own, even if you know your diagnosis. Today there are 6 classes of drugs for high blood pressure, and they all have a different principle of action and list of indications and, most importantly, contraindications. If you choose a medicine on the advice of a neighbor, articles from the Internet, or just at random, because you have heard the name of this medicine, you can not only not reduce your blood pressure, but worsen your condition. When choosing pills for pressure or drugs in any other forms (capsules, injections, intravenous infusions), the doctor is guided by a number of criteria.Effective pills for high blood pressure from this group are prescribed most often to young people. If the remedy is not combined with others, then therapy lasts no more than four weeks. Then drugs for hypertension that fit the patient are combined with drugs from other groups. The drug should not be taken for a long time due to the high risk of mortality, hypotension and fainting. At first, in the first days or a week of treatment, unpleasant symptoms may appear. Rapid-acting high pressure tablets cause weakness and dizziness in patients when changing body position.The most commonly used pills for high blood pressure: Enalapril. The danger of high pressure for the body, the causes of the development of hypertension. Types of drugs used for acute and chronic disorders, their mechanisms of action and effectiveness. The type of tablets, their dosage, the frequency of administration, the duration of the course are also determined separately for each patient. The age, stage of hypertension, the reasons that caused it, concomitant diseases are taken into account. In most cases, patients need drug correction all the time.There are 6 groups of medicines for the normalization of high blood pressure. They all have different mechanisms of action and are available by prescription. Calcium antagonists. Losartan is best taken for high blood pressure in primary hypertension and congestive heart failure. Differs in long-term action – more than 24 hours. Losartan film-coated tablets 50 mg 90 pcs. The list of the best pills for high blood pressure is recommended for informational purposes. With arterial hypertension, self-medication is unacceptable.Effective new generation drugs for high blood pressure can only be prescribed by a doctor. The specialist will conduct an examination, take into account the test results and the individual characteristics of the patient’s body. It is not easy to buy a good medicine for high blood pressure. The pharmacist in the pharmacy will rarely help, he immediately sends to the doctor. Is it really that hard to recommend a reliable drug at an affordable price? Blood pressure is considered elevated if its value is 140/90 mm Hg. Art. or higher, regardless of the person’s age.Most often, an increase in pressure is an independent disease, which is called hypertension. Indeed, why take pills if you feel good? Alas, the frequency of complications of hypertension does not depend on whether you feel it or not. Hypertension can cause serious complications. Terrible complications: myocardial infarction. Groups of drugs for hypertension. There are five main classes of drugs for the treatment of hypertension. Probably the most famous are β-blockers (propranolol, carvedilol, metaprolol, nebivolol).If there is no effect from small doses of the selected drug, they switch to full doses. If the pressure does not decrease from them, the same scheme is tried in turn with several other drugs. And only if after such a bust it is not possible to achieve control of blood pressure, the doctor proceeds to the appointment of combination therapy. Immediately with the appointment of two (and sometimes more) drugs, they begin if the target organs are already affected or if the patient has many of the risk factors listed above. The fact that you need to take drugs for pressure can be understood by the following symptoms: headaches; dizziness.In order to avoid overdose, before using the drug for high blood pressure, you must carefully read the instructions for use. Forms of release. The most popular on the list of drugs for pressure are pills. This is due to the convenience of their use anywhere, wherever a person is. However, when the pressure is very high, doctors prefer injections. In the Gorzdrav catalog you can buy medicines for hypertension not only in tablets, but in: ampoules; solutions for intravenous / intramuscular administration; drops.For whom. Medical reference book of medicines to reduce blood pressure in the Internet pharmacy www.piluli.ru. Prices. Instructions. Free shipping. Medicines to lower blood pressure. Hypertension is a pathology that, according to the latest research data, affects every third person out of ten. The danger of the disease is that it often leads to complications – heart attacks and strokes. Therefore, drugs for lowering blood pressure have been produced by all pharmaceutical companies for many years. Types of medicines.All antihypertensive drugs, on whatever basis they are created, perform their main function – to reduce blood pressure to the normal level. High blood pressure pills do not cure hypertension. They only relieve blood pressure while you are on medication. But as soon as you stop taking these pills, the pressure jumps to its previous high numbers. Or even higher. That is, pressure pills are exclusively symptomatic treatment that does not affect the causes of high blood pressure, and does NOT eliminate these causes.Relatively speaking: When taking drugs, the recipient was always in a good mood. When taking pressure pills, the patient always had good blood pressure. And I have to remind you that pressure pills must be taken for life, their side effects accumulate. Take antihypertensive drugs – medicines that lower blood pressure. When should you start taking pills regularly? One of the most common reasons is forgetting to take pills. To do this, there is a toothbrush rule – put the tablets next to the toothbrush, brush your teeth and take the tablets.What are the side effects of antihypertensive drugs? Each of the antihypertensive drugs can have side effects. The likelihood of the appearance and severity of a side effect depends on the dose: the higher it is, the more likely the risk of side effects – which is why the doctor strives to prescribe the optimal doses of drugs.

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Each package of Aroforte contains instructions that must be read carefully and the treatment regimen must be learned.Capsules are taken 2 times a day, morning and evening, with plenty of water. In the case of mild hypertension, it is sufficient to drink 1 capsule daily. With significant pressure surges, the medicine is recommended to be drunk 3 times a day, regardless of food intake. The course of treatment is 1 month. For the prevention of hypertension, Aroforte is taken in courses 1-2 times a year as prescribed by a doctor. In clinical trials, experts have proven that Aroforte eliminates the root cause of the disease, and not just its symptoms.The drug does not cause allergic reactions, does not disrupt metabolism and eliminates disorders of the nervous system. Aroforte normalizes hormones, stimulates metabolism, restores the correct functioning of the digestive tract, activates cell regeneration, prevents the formation of blood clots, and improves the chemical composition of blood. Already in the first 3-4 days of using the Aroforte capsules, judging by the reviews, it stabilizes blood pressure, dyspnea, chills, throat throbbing, internal tension disappear, redness and headaches stop.

90,000 To drink or not drink blood pressure medications daily?

“Slow killer” – this is what is often called high blood pressure (BP), or arterial hypertension (AH) (essential hypertension). This is due to the fact that often the disease has no symptoms for some time (especially in a strong half of humanity) and a patient who has high blood pressure for years may know about it.

It would seem that there is and is.And what’s so special about that?

The fact is that it is not the numbers themselves that are displayed on the pressure measuring device (tonometer) that are dangerous, but the complications to which they slowly but surely lead. Organs – “targets” for hypertension are the heart (left ventricular hypertrophy, ischemia, infarction, heart failure), the brain (encephalopathy, stroke), eyes (retinal pathology, hemorrhage, up to loss of vision), kidneys (nephropathy up to terminal stage of renal failure), vessels (aneurysm “expansion” of the aorta with a possible rupture).And most importantly, almost all of these pathologies develop gradually, imperceptibly for a person, until pronounced and often irreversible pathologies appear.

Although hypertension is currently considered incurable, like diabetes mellitus, it is quite possible to maintain blood pressure at an optimal level (120-140 / 80-90 mm Hg).

In the treatment of almost any disease, the first point is the change (modification) of the lifestyle. There is such a point in the AG.

This effect on conditionally eliminable risk factors: weight loss in obesity (especially abdominal), smoking cessation, alcohol abuse, fighting hypodynamia (the likelihood of developing hypertension in people leading a sedentary lifestyle is 50% higher), limiting salt intake (about 1 hourl. per day). If you have hypertension only in the initial stage and the pressure numbers are small, then sometimes only these measures lead to the normalization of blood pressure.

But most often a cardiologist (therapist) is faced with patients who have had hypertension for many years and have very high blood pressure figures. Therefore, it is not possible to do only with a change in lifestyle and is contrary to all modern standards of treatment. Therefore, your doctor prescribes drug therapy, sometimes in the form of one tablet, and sometimes 4-5 groups of drugs have to be used to achieve the target figures (especially often there is a need for this in case of advanced renal failure, diabetes mellitus).It is important to remember that lifestyle changes increase the effectiveness of drugs and may even allow for lower doses of those drugs.

Before choosing a drug, a competent specialist will carefully collect anamnesis, assess the existing risk factors, conduct a physical examination and prescribe you various laboratory tests and diagnostic procedures to clarify the degree of damage to organs – “targets”, including a clinical analysis of blood, urine, ECG, glucose , blood lipids, ultrasound of the heart.

For the treatment of hypertension, various drugs are used: ACE inhibitors, sartans, diuretics, beta-blockers, Ca antagonists, etc. Patients respond (react) to drugs in different ways: some may experience side effects, which in most cases can be reduced or completely eliminate by reducing the dose of the drug or replacing it with another.

But what you need to remember is that hypertension needs to be treated EVERY DAY !!! Because, again, by analogy with diabetes mellitus, the pressure will be within normal limits (like blood sugar) as long as the drug is active.

Some may say: “I sometimes do not take pills for 2-3 days, but my blood pressure is normal.” This is due to the fact that the period of complete elimination in modern antihypertensive drugs can reach 72 hours, especially in patients with renal pathology. Such, as it were, a “game” in the treatment (I drink, then I do not drink), can turn into a fatal mistake. Hypertensive disease is very insidious and can “hide” for a while, and then return with a shot of a hypertensive crisis with severe complications. Moreover, chronic complications can be influenced (to reduce their manifestation, for example, regression of left ventricular myocardial hypertrophy), but only if your pressure is within the optimal range (120-140 / 80-90 mm Hg).Art.) within 95% of the time, i.e. daily (day and night) for more than 1 year.

And most importantly, do not self-medicate !!! An incorrectly selected drug can only harm! What is good for your neighbor may turn out to be poison for you!

If your blood pressure even periodically rises, do not expect it to worsen! Contact a cardiologist at the Doctor Lea Medical Center and our specialists will help you solve this problem.

The author of the article: cardiologist Tatyana Vladimirovna Zolotareva.

Answers to questions

00:00

Arutyunov Grigory Pavlovich , Doctor of Medical Sciences, Professor:

– According to the scenario of our today’s event, I have questions, which I will now briefly try to answer. I will read the question and give a short answer to it.

Question: Is Torasemide effective in all patients?

– Yes. Prospective studies have shown that it is much more effective than Furosemide.Transfer of patients who received “Furosemide” to “Torasemide” gave a greater diuretic effect.

Question: Are there any patients in whom Furosemide should be preferred?

– When choosing one or another diuretic, you should be guided, first of all, by the indicators of this drug, for the half-life. Firmly remember that the longer the half-life of the drug, the less toxic the effect. The second indicator is whether there are additional positive effects.In particular, does it affect mortality. Torasemide reduces mortality, especially sudden death.

Question: Does it have any other additional effect.

– Please note that with equal excretion of potassium, there is no peak potassium excretion on Torasemide. This means that the risk of rhythm disturbance on Torasemid does not increase.

Question: One more question related to Torasemid. From my own experience I know that “Torasemide” in some patients is less effective than “Furosemide”.

– This is not the case because I will again refer to large prospective clinical trials. It is much more important to remember that 10 mg of Torasemide is equivalent to 40 mg of Furosemide.

Dr. Drachev asks a question.

Question: When is the combined use of Torasemide and Spironolactone indicated?

– Diuretics plus Spironolactone at a dose of 25 mg for life, starting from the third functional class, regardless of whether sinus rhythm or atrial fibrillation.Lifelong therapy.

Question: What is the fundamental difference between Veroshpiron and Eplerenone? What is the place of Eplerenone in the treatment of chronic heart failure?

– “Veroshpiron” differs from “Eplerenone” only in one thing – the removal of two radicals, which changed its sexual action. Gynecomastia does not develop with prolonged use. Currently, “Eplerenone” has been tested in patients who have survived myocardial infarction and has proven its effect on reducing the risk of death.First of all, by reducing sudden deaths.

02:22

Question: Large doses of Furosemide are used in urgent therapy. What is the maximum safe dose of “Furosemide” in urgent therapy?

– There is no such dose. It must be clearly remembered that when starting therapy with 80 mg, one must ask oneself a question: if you do not see a diuretic effect, what is happening. Or the wrong way of introduction. For example, edematous syndrome does not allow for effective intramuscular administration and oral administration.Switch to intravenous administration.

If bolus fails, switch to IV dosing. After this, do not seek to increase the dose. On the contrary, take the path of combination therapy. You have a method of joining hydrochlorothiazide or potassium-sparing diuretics for diuretic therapy. It depends on the specific situation.

It is much more important to remember something else. Any increase in the dose of diuretics is toxic. It will always negatively affect the level of the state of the glomeruli, will lead to a decrease in the rate of glomerular filtration.Will affect electrolyte balance. Will increase the likelihood of rhythm disturbance. Forced diuresis (in large doses, one must always think about forced diuresis) will lead to a change in the volume of circulating blood and create ideal conditions for deep vein thrombosis and embolism in the pulmonary artery.

Question: Numbers 139/79 mm Hg. Art. talk about normal blood pressure?

– But that’s high normal.

Question: How can a practitioner determine the level of blood pressure with an accuracy of 1 mm?

– By repeated measurement and finding the average figure, if you always show border values ​​as a result.

Question: Any technical device gives an error. This error will be greater than 1 mm. So again it is impossible to determine the level of blood pressure with such an accuracy of 1 mm?

– If you make a decision and it really matters to you 140 or 139, measure several times, find the average. But it is a thousand times more important that you paid attention to those risk factors that the patient has and determined his true prognosis, the likelihood of his cardiovascular death.Then that decision would be made.

04:38

Question: Will there be any changes in the recommendations for the treatment of CHF? If so, which ones?

– Yes, they will. Naturally. In the coming months, a new draft will be posted on the Heart Failure Society website and will be discussed during the year. In particular, there will be a chapter related to chronic obstructive pulmonary diseases, trophological additions will appear.

Large national surveys completed.These will probably be quite significant changes in the modern text.

Question: What place does Aliskiren take in the treatment of CHF?

– At the moment, there is no strictly defined place for Aliskiren in the treatment of CHF. But we must remember that in patients with CHF, the entire neurohormonal profile is impaired, including increased renin activity. However, excessive blockade of neurohormones has never led to any significant success. On the contrary, it worsened the prognosis. Today, a blockade consisting of three components is considered safe.These are the effects on norepinephrine, angiotensin II and aldosterone levels.

Question: Do the approaches to the treatment of systolic and diastolic CHF differ?

– Yes, they will be fundamentally different. At the moment, there are no hard decisions about the treatment of diastolic circulatory failure. A number of studies (in particular “Ara”) have not shown any benefits in the treatment of diastolic circulatory failure.

Question: On the use of “Torasemide” in children.

– There is no such data. All patients included in the study were over 18 years of age. Thank you for your attention.

06:10

Oganov Rafael Gegamovich , President of the All-Russian Scientific Society of Cardiology, Academician of the Russian Academy of Medical Sciences, Doctor of Medical Sciences, Professor:

Question: What are the statistics on cardiovascular mortality over the past 5 years? Is the average age at deaths from cardiovascular disease changing?

– Statistics are favorable.Since 2003, there has been a decrease in mortality from cardiovascular diseases. It is difficult to say how stable these statistics will be in the future, because various demographic processes are interfering. They do not depend on our actions and desires. But so far the statistics are favorable. There was a decrease of about 15 percent in comparison with 2003.

Question: Is the average age of death changing?

– It’s very difficult to say. We can say only if we compare the mortality rate at working age in our country and in the countries of the European Union, then it is about 5-6 times higher than in the countries of the European Union.

Question: Question about risk factors. There is evidence that obese people live not much less than people with normal body weight. How can this be explained?

– I have an article and lecture called “Paradoxes of Preventive Cardiology.” Yes, there are indeed quite a few studies that concern patients with coronary heart disease. They show that the prognosis in people with increased overweight and obesity is better than in people with normal body weight.

It is difficult to say what this is connected with. Although a recent study has emerged that shows that the criteria and methods for overweight that we use are not entirely appropriate. In particular, we use body mass index. This index has been commonly used in clinical trials.

Compare how BMI predicts outcome, abdominal obesity, as measured by waist circumference. It turned out that if we take abdominal obesity, it turns out very clearly, as we thought before.The larger the waist circumference, the higher the mortality rate. If we take the body mass index, there is often an inverse relationship. The higher the body mass index, the better the prognosis. Apparently, the body mass index is simply not suitable for assessing the prognosis in individuals who already have coronary heart disease.

08:39

Question: What are the acceptable minimum diastolic blood pressure figures?

– Yuri Alexandrovich has already said. I won’t.

Vladimir Trofimovich Ivashkin , Academician of the Russian Academy of Medical Sciences, Doctor of Medical Sciences:

– Thank you.Please, Yuri Alexandrovich.

Yuri Aleksandrovich Karpov , Doctor of Medical Sciences, Professor:

– I have quite a few questions. I will try to answer briefly.

Question: One of the questions. The target pressure level (what I talked about in the recommendations) is office, daily average or central pressure readings?

– 130/139 is the so-called office pressure, that is, what is registered at the doctor’s appointment.We don’t think the range is narrow. Moreover, this is an indicative level. If it turned out to be slightly lower, then this is allowed if the patient tolerates such a decrease well.

We have a lower limit for lowering blood pressure. I also talked about her. The only thing that is unacceptable is that the pressure is more than 140 mm Hg. Art. This is the most important parameter.

Next moment. Pressure control in people over 85 years old, who have not been controlled for a long time, and adapted to high numbers.In old age, the basic principle is a gradual decrease in blood pressure. There is now evidence that in people over 80 years of age, blood pressure control provides patient benefits. This was shown in the Hyvet study. I mentioned it briefly.

Today we do not have age restrictions to control the level of blood pressure, including those over 85 years old. The optimal level for them is less than 150 mm Hg. Art.(systolic).

10:24

Question: What is the clinical significance of a decrease in diastolic pressure of less than 60 mm with effective control of isolated systolic arterial hypertension?

– This clinical significance is not entirely clear. But it is clear that the higher the pulse pressure, it will be worse in terms of prognosis. There were no special studies. From my point of view, in this case, the most important indicator is the controllability of systolic pressure.It is with the control of systolic blood pressure that the greatest problems are now encountered.

Question: From one of our listeners, from the sixth year student Ruchkin, I have a large number of questions concerning the method of measuring blood pressure and some other points.

– I can say the following. When measuring pressure, the volume of the patient’s arm must be taken into account. If you are overweight in obese patients, larger cuffs should be used. There is a corresponding gradation in the size of the cuff.Of course, an electronic tonometer in comparison with a mechanical one has a large degree of error. We must take this into account. There is such a rule. It is necessary to measure blood pressure with a device that is periodically checked. Accordingly, you must trust this device.

The blood pressure figures given here by our listener. Of course, in many respects there is a certain degree of conventionality in the definition of what is called arterial hypertension, which we refer to as arterial hypertension.Moreover, in recent years, we have changed the boundaries of the norm and pathology with an increase in blood pressure.

The diagnosis of arterial hypertension is, of course, determined by the blood pressure figures, which have been registered as elevated several times (more than 140 mm Hg). But the second very important point – this, of course, should be supported by an assessment of the state of target organs, risk factors. Everything should be considered as a whole.

On the one hand, the diagnosis is simple. On the other hand, of course, patient assessment requires some diagnostic effort.This is all very clearly spelled out in our recommendations.

12:55

Vladimir Ivashkin : Yuri Alexandrovich, I also read the questions of this curious student. I think that the tendency of changes in blood pressure in the process of monitoring the patient and in the course of treatment is very important. Not just a baseline, a trend where this is all going.

Yuri Karpov: Yes, of course, Vladimir Trofimovich. This is a very important point, because for us, in the final goal, optimal control is extremely important.Here, of course, it is necessary to achieve an optimal result, to use all the possibilities of drug therapy and what Rafael Gegamovich was talking about. We must not forget the non-drug effect on blood pressure.

Question: Another very interesting moment is asked by a student. Is it possible to develop atherosclerosis with a normal cholesterol level?

– In general, yes. As, however, and the opposite. With high cholesterol, we may not find signs of atherosclerosis.Everything will depend on what technique we use for diagnostics. This is a very big question, of course. Maybe someday we will have a separate meeting to devote to this.

Question: What is the difference between the pulse pressure and the central one? What is worse predictively?

– If there is data on the value of the pulse pressure in terms of the forecast, then the central pressure is a relatively new indicator. It has not yet (as far as I know) been used as a prognostic factor.Although this is very interesting and could expand our possibilities for clarifying the prognosis in a patient with arterial hypertension, which, by the way, is not as simple as it sometimes seems to us.

14:40

Question: With which group of drugs is it more expedient to start therapy in elderly patients?

– Priorities are given to two classes of drugs. These are diuretics and calcium antagonists. But in general, we do not have any prohibition on the use of other antihypertensive drugs.We can use the full range of antihypertensive medicines.

Question: What is the place of renin inhibitors in antihypertensive therapy? Why are they not included in the combination therapy regimen?

– Direct renin inhibitors (first of all, this is the drug Aliskiren, which is registered and used for the treatment of arterial hypertension) occupy the position of additional classes of antihypertensive drugs.

This is due to the fact that to date we do not have data regarding the effect of Aliskiren on the long-term outcomes of arterial hypertension.We have data on blood pressure control, on the effect on some organ lesions, on the combination of Aliskiren with various drugs. But there is no data on long-term outcomes.

In terms of combination therapy, Aliskiren, as well as other drugs belonging to the class that block the activity of the renin-angiotensin system, are most beneficial in combination with diuretic drugs and calcium antagonists. Today it is an interesting and promising direction.

Question: Please tell us more about the “Strong” study.

– The Strong Study is a large study that we refer to as real-life clinical practice. More than a thousand patients whose blood pressure was not controlled either against the background of one, or two, or several classes of antihypertensive drugs. Or untreated patients. The therapy was canceled, and the patients were transferred to the combination of Perindopril with Amlodipine.

In this study, this combination was shown to have a huge advantage in improving blood pressure control.

Question: Which term is correct: antihypertensive therapy (or drug) or antihypertensive therapy?

– For us, of course, the most important point is antihypertensive treatment. We must keep blood pressure from rising. Let it not surprise you that a patient with arterial hypertension takes a drug that lowers blood pressure when his blood pressure is normal. It is important that blood pressure does not rise.

Antihypertensive therapy is applied to a situation when high blood pressure and you need to lower this blood pressure.It is quite appropriate here. But in general, it is better to use the terminology “antihypertensive therapy” and address this issue accordingly.

17:33

Question: A very important question. Isn’t the combination of Trandelapril and Verapamil better?

– Apparently doctors are comparing them with a combination of Perindopril and Amlodipine. I can say that it is not better, at least. I can support this with the results of research in the comparative plan of “Ascot”. There, the combination of Amlodipine with the addition of Perindopril was significantly more effective with a decrease in mortality compared to a beta-blocker and a diuretic.

The counterbalance to this research is “INVEST”. There, the combination based on Verapamil with the addition of Trandelapril to many patients turned out to be the same as the therapy based on Atenolol with the addition of a diuretic.

Comparison of the two studies allows us to say that the combination of Trandelapril with Verapamil is definitely not better. If, nevertheless, extrapolating the results, then it turned out to be no more effective than a beta-blocker and a diuretic.

Question: What drugs are optimal for arresting a hypertensive crisis?

– When it comes to oral medications, then by far the most widely used drugs are fast acting.This is one of the ACE inhibitors – Captopril. It is not very good for long-term treatment because it needs to be taken several times a day. But he acts quickly. Taken under the tongue, it lowers high blood pressure figures within half an hour.

Then we use drugs of the short-acting nifedipine group, calcium antagonists. They are also not suitable for long-term treatment, but they are good for arresting a hypertensive crisis that is not severe. Clonidine in general can also be used in a situation of rapid blood pressure lowering.But it is not very good for long-term treatment due to the fact that it has some undesirable effects.

19:47

The last question, dear colleagues, which I have.

Question: What new things did the Cardio Congress in Paris bring?

– Of course, in a nutshell it is difficult, but I will still try to express my personal opinion on the results of the Paris Congress of European Cardiology. It was a huge event. A huge number of participants.

In recent years, European congresses in terms of the number of participants, in scale have become larger than the American ones, which for many years have been a kind of standard for the mass scale of the event and interest in terms of results.

The main slogan of this congress was the analysis of controversial situations in cardiology. A huge number of activities were associated with expressing the opposite point of view on diagnostics, on treatment, on the use of different methodological approaches.It was certainly interesting. Especially for young cardiologists, because a lot has been done.

It is important to analyze the research carried out, to understand the values ​​of a particular method of diagnosis and treatment. This year, perhaps, for the first time, registers were discussed so actively. Apparently, in the coming years, registers will be the main sources of information for assessing the situation in cardiology. This is primarily due to the fact that the number of studies in cardiology has significantly decreased in recent years.

Now what is important to us is the results on how effectively we are using everything that has been developed in recent years.

21:28

Another fundamentally important issue regarding the results of the Congress. He sounded in the report of Professor Salem Yusuf, a very famous figure who is engaged in clinical research. He presented data from one of the registries, which analyzed the frequency of use of different drugs to reduce the risk of complications in patients in different countries.High income, middle income and low income.

He expressed a very important point of view that today it is much more important for us to apply everything that has already been developed and created to reduce the risk of complications. Including cheap drugs that are absolutely available to the overwhelming number of patients than, for example, the creation of new drugs, the effectiveness of which requires more efforts in terms of improving the prognosis. It is necessary to implement everything that has already been developed today.

From the point of view of the clinical research itself, which was, I was most impressed by the results of the Aristotle study. This is the treatment of patients with atrial fibrillation with the anticoagulant pexoban.

For the first time, an advantage over warfarin therapy was shown not only in terms of reducing the risk of complications, but also a significant decrease in mortality in the group of patients who received pexoban. But the most important thing, perhaps, is the high degree of safety of such therapy.The risk of bleeding was significantly less than in the Warfarin group. These are the most important impressions, the results of the last European Congress of Cardiology.

Vladimir Ivashkin : Thank you, Yuri Alexandrovich.

Now I will answer my questions very briefly.

Question: How long can I take Trimedat (Trimebutin)? This refers to patients with chronic abdominal pain.

– “Trimedat” (“Trimebutin”) is an opioid receptor agonist.Moreover, it is an agonist of non-central opioid receptors, therefore, it is not addictive, does not cause certain changes in mood and behavior. The main targets of this drug are peripheral opioid receptors. The gastrointestinal tract is characterized by a very dense distribution of opioid receptors. Activation of peripheral opioid receptors underlies the mechanism of action of “Trimebutin” (“Trimedat”).

It should be used depending on the patient’s response or the response of his painful sensations.The drug gradually develops its effect, shows its analgesic effect, therefore, it must be prescribed for at least a month. Then, if the effect is achieved, if good results are obtained, then the treatment must be continued. Treatment can be continued indefinitely or in long courses.

24:52

Question: Should patients with chronic abdominal pain be advised to consult a psychotherapist?

– Required. This is a prerequisite in order to understand the essence of the patient’s complaints.But which should come first: the attending physician or therapist. In the first place, of course, should be the attending physician. First of all, he must assess the clinical symptoms, whether the patient has symptoms of so-called anxiety.

What are the symptoms of anxiety. This is a fever (in the range of 37.5 – 38.5 ° C). This is weight loss. Especially when it comes to progressive weight loss. This is the appearance of blood in the stool (latent or overt). Such symptoms indicate that very close attention must be drawn to the patient.

After that, it is necessary to perform routine research at the moment. Do endoscopy of the upper gastrointestinal tract. Make an endoscopy of the large intestine, if possible, the distal parts of the small intestine. Do an ultrasound scan. View general clinical and general biochemical blood test.

In the overwhelming majority of cases, this is enough to get an idea of ​​the possible (if any) organic pathology and prescribe treatment.Usually, abdominal pain, when a specific cause is identified, subsides within a week after we prescribe treatment. If there is no improvement in the course of such an examination and in the course of the prescribed treatment, then consultation with a psychotherapist can serve as a good service.

26:56

What to look out for in patients with chronic abdominal pain. First of all, clinical symptoms. Secondly, a very thorough examination of the abdominal organs.Obligatory superficial and deep palpation. Do not forget that the stomach needs to be listened to, auscultated. Often, symptoms are detected during auscultation. Intestinal paresis. Silent belly.

It is imperative to investigate the possibility of identifying a pain symptom using a spinal change. Most often it is spondylitis.

Finally, the state of mental status is a very important factor.

Here’s an interesting question.

Question: Does the level of education affect the perception of pain?

– I think there is no direct correlation.Often highly educated people, if they find out about the diagnosis (they say to him: “You have a duodenal ulcer”), they calm down. They can be sick for years. They will not come to you again. They got the answer to their question. They know that duodenal ulcers in the vast majority of cases do not cause any serious complications.

A poorly educated person, due to a lack of understanding of what is happening to him, can endure for a long time. Moreover, he begins to be treated with folk remedies.What are the folk remedies in the first place. This is alcohol. Vodka. After that, an appeal to friends and so on for a possible recommendation. Sometimes we see such poorly educated patients who come to the clinic with an extremely neglected situation.

It is probably impossible to say that education and attitude to pain have a direct correlation. But still, of course, an educated person is a person who is able to be critical of himself and critical of what the doctor recommends to him.An educated person with greater responsibility and with unconditional more pronounced constancy will follow the doctor’s recommendations and carry out introspection.

The principle is simple. The principle applies to all cases in medical practice. This principle was expressed in his time by Bernard Shaw. He said that gentlemen who wear top hats and smoke cigars live longer than gentlemen who wear caps and smoke cigarettes. This is a social gradation.