The goal of therapy for patients 18 to 65 years of age is systolic blood pressure (SBP) less than 140 mm Hg and diastolic blood pressure (DBP) less than 90 mm Hg. The American Diabetes Association (ADA) Guidelines The 2017 Guideline for Management, Prevention, Detection, Evaluation of High Blood Pressure in Adults (ACC/AHA)Ĭonfirmed hypertension with known CVD or 10-year ASCVD risk greater than or equal to 10%: blood pressure less than 130/80 mm Hg is the recommended target. Confirmed hypertension without markers of increased ASCVD risk. Patients with systolic blood pressure <80 mm Hg, low serum sodium, diabetes mellitus, and impaired renal function should be closely monitored (ACC/AHA). Reevaluate blood pressure (including orthostatic blood pressure), renal function, and serum potassium. Monitor blood pressure, renal function (BUN and serum creatinine ), and potassium levels in patients taking losartan. The plasma clearance of losartan and EXP 3174 are through the kidney and liver, respectively. The onset of action of losartan is 6 hours, lasting for 24 hours, and the half-lives of losartan and EXP 3174 are 1.5 to 2 hours and 6 to 9 hours, respectively. Hepatic P450 enzyme CYP2C9 metabolizes losartan to a more potent 5-carboxylic acid metabolite, EXP 3174. įor this reason, the non-renin-angiotensin effects, for example, cough and angioedema, are not commonly seen with ARBs. ![]() Compared to ACE inhibitors, angiotensin II-receptor blockers effectively inhibit the renin-angiotensin system, not affecting the response to bradykinin. Losartan increases the urinary flow and increases the excretion of sodium, potassium, chloride, magnesium, uric acid, calcium, and phosphate. Losartan also inhibits angiotensin II-induced vasoconstriction and action of aldosterone, which in turn lowers the blood pressure. It inhibits angiotensin II-induced vasopressin release, adrenal catecholamine release, rapid and slow pressor response, thirst, cellular hypertrophy and hyperplasia, noradrenergic neurotransmission, and sympathetic tone increase. It binds with high affinity to the AT1 receptor and is more than 10000 fold selective for the AT1 receptor than the AT2 receptor. Losartan is a selective and competitive angiotensin II receptor blocker at the AT1 receptor site, resulting in a compensatory elevation of renin and angiotensin I levels. ![]() Angiotensin-converting enzyme further converts angiotensin I, an inactive decapeptide, to angiotensin II, an active octapeptide. Angiotensinogen is converted to angiotensin I by an enzyme, renin, that gets released from the juxtaglomerular apparatus of the kidney.
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