Losartan
Angiotensin II receptor blocker (ARB) for high blood pressure, diabetic kidney disease and heart failure
Losartan is one of the most widely prescribed angiotensin II receptor blockers (ARBs) worldwide. It works by blocking the action of angiotensin II, a hormone that constricts blood vessels and raises blood pressure. Losartan is used to treat hypertension in adults and children aged 6–18, protect kidney function in patients with type 2 diabetes and proteinuria, manage chronic heart failure, and reduce stroke risk in patients with high blood pressure and left ventricular hypertrophy. This guide covers dosage, side effects, drug interactions and essential safety information based on international clinical guidelines.
Quick Facts: Losartan
Key Takeaways
- Losartan is an ARB that lowers blood pressure by blocking angiotensin II receptors, with full effect reached in 3–6 weeks.
- It provides kidney protection in patients with type 2 diabetes and proteinuria, slowing progression of diabetic nephropathy.
- The LIFE study demonstrated losartan reduces stroke risk in hypertensive patients with left ventricular hypertrophy compared to atenolol.
- Losartan must not be used during the last 6 months of pregnancy due to risk of serious fetal harm including kidney damage.
- Common side effects include dizziness, low blood pressure and elevated potassium levels — regular blood monitoring is recommended.
What Is Losartan and What Is It Used For?
Quick Answer: Losartan is an angiotensin II receptor blocker (ARB) that relaxes blood vessels and lowers blood pressure. It is prescribed for hypertension, diabetic kidney protection, chronic heart failure, and stroke risk reduction in patients with left ventricular hypertrophy.
Losartan belongs to the class of medicines known as angiotensin II receptor antagonists, sometimes referred to as ARBs or sartans. Angiotensin II is a naturally occurring hormone in the body that binds to receptors on blood vessel walls, causing them to constrict and driving blood pressure upward. Losartan works by selectively blocking the AT1 receptor, preventing angiotensin II from exerting its vasoconstrictive effects. This leads to widening of the blood vessels, reduced blood pressure, and decreased strain on the heart.
Unlike ACE inhibitors, which block the conversion of angiotensin I to angiotensin II, losartan acts downstream by blocking the receptor itself. This mechanism means losartan is far less likely to cause the persistent dry cough that is a well-known side effect of ACE inhibitors. After oral administration, losartan is rapidly absorbed and undergoes hepatic first-pass metabolism to form an active metabolite known as EXP-3174, which is 10 to 40 times more potent than the parent compound. Peak plasma levels of losartan occur within approximately one hour, while the active metabolite peaks at three to four hours.
Losartan also has a unique uricosuric property not shared by other ARBs: it promotes renal excretion of uric acid, which may provide an additional benefit for patients with hyperuricemia or gout. This pharmacological feature has been documented in several clinical studies and distinguishes losartan from other members of its class.
Approved Indications
Losartan is approved for several important clinical indications, each supported by robust evidence from large-scale randomised controlled trials:
- Hypertension: Treatment of high blood pressure in adults and in children and adolescents aged 6–18 years. Lowering blood pressure reduces the risk of stroke, heart attack and kidney disease.
- Diabetic nephropathy: Renal protection in adult patients with type 2 diabetes, hypertension and laboratory evidence of impaired kidney function with proteinuria ≥0.5 g/day. The landmark RENAAL trial demonstrated that losartan reduced the risk of doubling serum creatinine by 25% and end-stage renal disease by 28% compared to placebo.
- Chronic heart failure: Treatment of chronic heart failure in adults when ACE inhibitor therapy is considered unsuitable by the treating physician. If heart failure is stabilised on an ACE inhibitor, patients should not be switched to losartan.
- Stroke risk reduction (LIFE indication): Reduction of risk of stroke in patients with hypertension and left ventricular hypertrophy. The LIFE study, involving over 9,000 patients followed for a mean of 4.8 years, showed losartan reduced the risk of stroke by 25% compared to atenolol, despite similar blood pressure reductions.
Losartan is available as generic tablets worldwide and is listed on the WHO Model List of Essential Medicines, reflecting its established safety profile and importance in global cardiovascular medicine. It is commonly prescribed as first-line therapy for hypertension, either alone or in combination with other antihypertensive agents such as hydrochlorothiazide.
What Should You Know Before Taking Losartan?
Quick Answer: Do not take losartan if you are allergic to it, are in the last 6 months of pregnancy, have severe liver impairment, or take aliskiren with diabetes or kidney disease. Tell your doctor about all medical conditions and medications before starting treatment.
Before starting losartan, your doctor needs a comprehensive picture of your medical history. Several conditions and circumstances can affect whether losartan is appropriate for you, or whether your dosage needs to be adjusted. Being open with your healthcare provider about your health will help ensure that losartan is used safely and effectively.
Contraindications
- You are allergic to losartan or any of the other ingredients (including lactose monohydrate)
- You are in the last 6 months of pregnancy (it should also be avoided earlier in pregnancy)
- You have severe hepatic (liver) impairment
- You have diabetes or impaired kidney function and are being treated with a blood-pressure-lowering medicine containing aliskiren
Warnings and Precautions
Talk to your doctor, pharmacist or nurse before taking losartan if any of the following apply to you. Your doctor may need to monitor you more closely, adjust your dose, or consider an alternative medication:
- History of angioedema: If you have previously experienced swelling of the face, lips, throat or tongue (angioedema), whether from losartan or other medicines including ACE inhibitors, you are at increased risk of recurrence. Angioedema can be life-threatening if it involves the airway.
- Dehydration or salt depletion: If you have been ill with vomiting or diarrhoea causing significant fluid and electrolyte loss, or if you are on a strict low-salt diet, you may be at increased risk of severe hypotension (low blood pressure) when starting losartan.
- Diuretic therapy: Patients taking high-dose diuretics (water tablets) may experience an exaggerated blood pressure drop when losartan is introduced. Your doctor may reduce your diuretic dose or start losartan at a lower dose.
- Renal artery stenosis: If you have narrowing or blockage of the blood vessels leading to one or both kidneys, or have recently undergone a kidney transplant, losartan can worsen kidney function and should be used with extreme caution.
- Hepatic impairment: Patients with mild-to-moderate liver problems may need a lower starting dose because losartan is extensively metabolised by the liver. Losartan is contraindicated in severe hepatic impairment.
- Heart failure: If you have heart failure with or without impaired kidney function, or concurrent serious cardiac arrhythmia, particular caution is required. Special care is also needed if you are simultaneously taking a beta-blocker.
- Heart valve disease or cardiomyopathy: If you have problems with your heart valves or heart muscle, your doctor will monitor you carefully.
- Coronary artery disease or cerebrovascular disease: If you suffer from reduced blood flow to the heart or brain, dose adjustments may be necessary.
- Primary hyperaldosteronism: Patients with this adrenal gland disorder typically respond poorly to antihypertensive drugs that act on the renin-angiotensin system, including losartan.
- Dual RAAS blockade: Taking losartan with an ACE inhibitor or aliskiren increases the risk of low blood pressure, elevated potassium and kidney problems. This combination is generally not recommended, especially in patients with diabetic kidney disease.
Your doctor should regularly check your kidney function, blood pressure and electrolyte levels (particularly potassium) while you are taking losartan. This is especially important in the first few weeks of treatment and whenever the dose is changed.
Pregnancy and Breastfeeding
Losartan must not be used during the last 6 months of pregnancy. Use during the second and third trimesters has been associated with serious fetal and neonatal toxicity, including reduced kidney function, oligohydramnios (low amniotic fluid), skull ossification defects, limb contractures, hypotension and even death. It should also be avoided during the first trimester as a precautionary measure. If you discover you are pregnant, contact your doctor immediately to discontinue losartan and switch to a safer alternative.
Losartan is not recommended during breastfeeding. It is not known whether losartan passes into breast milk in humans, but it does in animal studies. If you wish to breastfeed, your doctor may prescribe an alternative medication, particularly if your baby is newborn or was born prematurely.
Children and Adolescents
Losartan has been studied for the treatment of hypertension in children and adolescents aged 6 to 18 years. It is not recommended for children under 6 years of age, as efficacy has not been demonstrated in this age group. Losartan is also not recommended for children with kidney or liver problems due to limited available data in these populations.
Driving and Operating Machinery
No formal studies on the effect of losartan on the ability to drive or operate machinery have been conducted. However, like many blood-pressure-lowering medications, losartan can occasionally cause dizziness or drowsiness, particularly at the start of treatment or when the dose is increased. If you experience these symptoms, do not drive or operate heavy machinery until you know how losartan affects you. Discuss this with your doctor if the symptoms persist.
How Does Losartan Interact with Other Drugs?
Quick Answer: Losartan has clinically significant interactions with potassium supplements, potassium-sparing diuretics, NSAIDs, lithium, ACE inhibitors and aliskiren. Always tell your doctor about all medications you are taking, including over-the-counter drugs and supplements.
Drug interactions can alter the way losartan works or increase the risk of serious side effects. It is essential to inform your doctor and pharmacist about every medication you are taking, including prescription drugs, over-the-counter medicines, vitamins and herbal supplements. The most important interactions are categorised below based on their clinical significance.
Major Interactions
| Drug / Class | Interaction | Clinical Significance |
|---|---|---|
| Potassium supplements & salt substitutes | Additive hyperkalemia risk; losartan raises serum potassium by reducing aldosterone secretion | Avoid concurrent use unless directed by your doctor with regular potassium monitoring |
| Potassium-sparing diuretics (amiloride, triamterene, spironolactone) | Significant risk of hyperkalemia due to combined potassium-retaining effects | Not recommended together; if essential, frequent serum potassium monitoring required |
| ACE inhibitors (enalapril, lisinopril, ramipril) | Dual RAAS blockade increases risk of hypotension, hyperkalemia and renal impairment | Avoid combination, especially in patients with diabetic nephropathy |
| Aliskiren | Triple RAAS blockade; markedly increases risk of adverse renal and cardiovascular events | Contraindicated in patients with diabetes or renal impairment; avoid in all other patients |
| Lithium | Losartan can reduce renal lithium clearance, leading to toxic lithium levels | Combination not recommended; if unavoidable, close monitoring of serum lithium levels is essential |
| Heparin | Heparin can suppress aldosterone production, compounding hyperkalemia risk | Monitor serum potassium closely during concurrent use |
Other Notable Interactions
| Drug / Class | Effect | Advice |
|---|---|---|
| NSAIDs (ibuprofen, diclofenac, naproxen, COX-2 inhibitors) | Can reduce the blood-pressure-lowering effect of losartan and worsen kidney function | Use with caution; ensure adequate hydration and monitor renal function |
| Other antihypertensives | Additive blood pressure lowering; increased risk of hypotension | Expected in combination therapy; dose adjustment may be needed |
| Tricyclic antidepressants, antipsychotics | May enhance hypotensive effect of losartan | Be aware of increased dizziness or lightheadedness |
| Baclofen, amifostine | May increase risk of low blood pressure when combined with losartan | Monitor blood pressure closely |
| Trimethoprim-containing medicines | Can increase serum potassium levels | Monitor potassium levels regularly during combined use |
Losartan can be taken with or without food. Alcohol may enhance the blood-pressure-lowering effect and increase the risk of dizziness and lightheadedness. Drink alcohol in moderation while taking losartan and be cautious when standing up quickly.
What Is the Correct Dosage of Losartan?
Quick Answer: The usual starting dose for hypertension in adults is 50 mg once daily, with a maximum of 100 mg. For heart failure, treatment starts at 12.5 mg once daily and is gradually increased to a maintenance dose of up to 150 mg once daily. Always follow your doctor's instructions.
Always take losartan exactly as your doctor or pharmacist has told you. The dose depends on your medical condition, other medications you are taking, and your individual response to treatment. Losartan tablets should be swallowed whole with a glass of water. Try to take your daily dose at the same time each day to maintain steady blood levels of the medication.
Adults — Hypertension
| Patient Group | Starting Dose | Maintenance Dose | Maximum Dose |
|---|---|---|---|
| Standard adult | 50 mg once daily | 50–100 mg once daily | 100 mg/day |
| Patients on high-dose diuretics | 25 mg once daily | 50–100 mg once daily | 100 mg/day |
| Hepatic impairment (mild-moderate) | 25 mg once daily | As tolerated | Individualised |
| Patients over 75 years | 25 mg once daily | 50–100 mg once daily | 100 mg/day |
The maximum blood-pressure-lowering effect is typically achieved within 3 to 6 weeks after starting treatment. If adequate blood pressure control is not achieved with the maximum dose, your doctor may add another antihypertensive medication such as a thiazide diuretic (e.g. hydrochlorothiazide) or a calcium channel blocker.
Adults — Diabetic Nephropathy (Type 2 Diabetes)
Diabetic Nephropathy Dosage
Treatment usually starts at 50 mg once daily and may be increased to 100 mg once daily depending on blood pressure response. Losartan can be used in combination with other antihypertensive agents (diuretics, calcium channel blockers, alpha-blockers, beta-blockers, centrally acting agents) as well as with insulin and commonly used oral antidiabetic drugs (sulfonylureas, glitazones, glucosidase inhibitors).
Adults — Heart Failure
Heart Failure Dosage — Gradual Titration
Treatment begins at 12.5 mg once daily and is increased in weekly steps:
- Week 1: 12.5 mg once daily
- Week 2: 25 mg once daily
- Week 3: 50 mg once daily
- Week 4: 100 mg once daily
- Week 5 onward: Up to 150 mg once daily (maximum)
Losartan is usually combined with a diuretic and/or digitalis and/or a beta-blocker in heart failure treatment. The target maintenance dose is determined by your doctor based on your tolerance and clinical response.
Children and Adolescents (6–18 Years) — Hypertension
Paediatric Dosage
For children weighing 20 to 50 kg: The recommended starting dose is 0.7 mg/kg body weight once daily (up to 25 mg). The dose may be increased if blood pressure control is inadequate. For children weighing over 50 kg, the adult dosage schedule applies. A liquid formulation may be more suitable for some children — consult your doctor or pharmacist. Losartan is not recommended for children under 6 years or for children with kidney or liver problems.
Missed Dose
If you accidentally miss a dose, take the next dose at the usual time. Do not take a double dose to compensate for the one you missed. If you frequently forget doses, consider setting a daily alarm or using a pill organiser to help you remember.
Overdose
If you take too much losartan, or if a child accidentally ingests the medicine, contact your local poison control centre or emergency services immediately. Symptoms of overdose may include low blood pressure (hypotension), rapid heart rate (tachycardia), and potentially slow heart rate (bradycardia). Treatment is supportive and may include intravenous fluids and monitoring of vital signs.
What Are the Side Effects of Losartan?
Quick Answer: Common side effects include dizziness, low blood pressure (especially in heart failure patients), fatigue and elevated potassium levels. Serious but rare side effects include angioedema, severe allergic reactions and significant kidney function changes. Seek immediate medical attention for facial swelling, breathing difficulties or widespread rash.
Like all medicines, losartan can cause side effects, although not everybody experiences them. Most side effects are mild and tend to improve as your body adjusts to the medication. The side effects listed below are classified by how frequently they occur, based on data from clinical trials and post-marketing surveillance.
A severe allergic reaction including rash, itching, swelling of the face, lips, mouth or throat that may cause difficulty swallowing or breathing. This is a serious but rare side effect (affecting between 1 in 1,000 and 1 in 10,000 patients) that may require emergency treatment or hospitalisation.
Common
Affects up to 1 in 10 patients
- Dizziness
- Low blood pressure (hypotension), particularly after significant fluid loss or in heart failure patients
- Dose-related orthostatic effects (blood pressure drop when standing up quickly)
- Weakness and fatigue
- Low blood sugar (hypoglycemia) in diabetic patients
- Excess potassium in blood (hyperkalemia)
- Changes in kidney function including kidney failure
- Decreased red blood cells (anaemia)
- Increased blood urea, serum creatinine and serum potassium (in heart failure patients)
Uncommon
Affects up to 1 in 100 patients
- Drowsiness and headache
- Sleep disturbances
- Palpitations (feeling of heart pounding)
- Chest pain (angina pectoris)
- Shortness of breath (dyspnoea)
- Abdominal pain, constipation, diarrhoea
- Nausea and vomiting
- Urticaria (hives), pruritus (itching), rash
- Localised oedema (swelling)
- Cough
Rare
Affects up to 1 in 1,000 patients
- Hypersensitivity reactions
- Angioedema (swelling of face, lips, throat) including intestinal angioedema
- Vasculitis (inflammation of blood vessels, including Henoch-Schönlein purpura)
- Paraesthesia (numbness or tingling)
- Syncope (fainting)
- Atrial fibrillation (irregular heartbeat)
- Cerebrovascular accident (stroke)
- Hepatitis (liver inflammation)
- Elevated liver enzymes (ALT), usually reversible on discontinuation
Frequency Not Known
Reported in post-marketing surveillance
- Decreased platelet count (thrombocytopenia)
- Migraine
- Abnormal liver function
- Muscle and joint pain (myalgia, arthralgia)
- Flu-like symptoms, back pain, urinary tract infection
- Photosensitivity (increased sensitivity to sunlight)
- Rhabdomyolysis (unexplained muscle pain with dark urine)
- Erectile dysfunction
- Pancreatitis (inflammation of the pancreas)
- Hyponatraemia (low sodium in the blood)
- Depression, malaise
- Tinnitus (ringing in the ears)
- Dysgeusia (taste disturbance)
Side effects in children are similar to those observed in adult patients. If you experience any side effect not listed here, or if any side effect becomes severe, contact your doctor or pharmacist. Reporting suspected adverse reactions helps ongoing monitoring of the medicine's benefit-risk balance.
How Should You Store Losartan?
Quick Answer: Store losartan at room temperature, away from moisture and direct sunlight. Keep out of sight and reach of children. Do not use after the expiry date printed on the packaging.
Proper storage of losartan tablets ensures they remain effective and safe throughout their shelf life. Following these storage guidelines will help maintain the quality of your medication:
- Temperature: No special temperature requirements. Store at room temperature (typically below 25°C / 77°F). Avoid exposure to excessive heat or cold.
- Moisture and light: Keep the tablets in their original packaging (blister pack or container) to protect them from moisture. Store away from direct sunlight.
- Children: Keep this medicine out of the sight and reach of children at all times.
- Expiry date: Do not use losartan after the expiry date stated on the carton or blister after “EXP”. The expiry date refers to the last day of that month.
- Disposal: Do not throw unused medicines in the drain or with household waste. Return unused tablets to your pharmacy for safe disposal to protect the environment.
What Does Losartan Contain?
Quick Answer: The active substance is losartan potassium. Tablets also contain inactive ingredients (excipients) including microcrystalline cellulose, lactose monohydrate, pregelatinised maize starch, magnesium stearate, hypromellose, titanium dioxide and macrogol.
Active Ingredient
The active substance in losartan tablets is losartan potassium. Each tablet contains a specific amount depending on the strength:
- 12.5 mg tablet: 12.5 mg losartan potassium
- 25 mg tablet: 25 mg losartan potassium
- 50 mg tablet: 50 mg losartan potassium
- 100 mg tablet: 100 mg losartan potassium
Inactive Ingredients (Excipients)
The other ingredients serve important manufacturing and stability functions:
- Tablet core: Microcrystalline cellulose, lactose monohydrate, pregelatinised maize starch, magnesium stearate
- Film coating: Hypromellose, titanium dioxide (E171), macrogol
Losartan tablets contain lactose monohydrate. If your doctor has told you that you have an intolerance to certain sugars, contact your doctor before taking this medicine.
Tablet Appearance
The appearance varies by strength:
- 12.5 mg: Blue, round film-coated tablet (diameter 5 mm)
- 25 mg: White, round film-coated tablet marked with “E” on one side (diameter 5 mm)
- 50 mg: White, round film-coated tablet with a score line on one side (diameter 8 mm). The 50 mg tablet can be divided into equal halves.
- 100 mg: White, round film-coated tablet (diameter 9.3 mm)
Tablets are supplied in blister packs in various pack sizes (28, 30, 56, 90, 98 or 100 tablets). Not all pack sizes may be available in all markets.
Frequently Asked Questions About Losartan
Both losartan (an ARB) and ACE inhibitors like enalapril work on the renin-angiotensin-aldosterone system (RAAS) but at different points. ACE inhibitors block the enzyme that converts angiotensin I to angiotensin II, while losartan blocks the AT1 receptor where angiotensin II acts. The practical difference for patients is that ARBs like losartan are significantly less likely to cause the dry persistent cough that affects 5–20% of patients on ACE inhibitors. Both classes are equally effective at lowering blood pressure and protecting the kidneys. Additionally, losartan has a unique uricosuric effect (lowers uric acid) not shared by ACE inhibitors.
No. Losartan must not be used during the last 6 months of pregnancy as it can cause serious harm to the developing baby, including kidney damage, low amniotic fluid (oligohydramnios), skull defects, and even death. It should also be avoided during the first trimester. If you are planning to become pregnant, your doctor will usually switch you to a safer blood-pressure medication before you conceive. If you discover you are pregnant while taking losartan, stop taking it and contact your doctor immediately.
Losartan begins to lower blood pressure within a few hours of the first dose, but the full antihypertensive effect takes 3 to 6 weeks to develop. This is why your doctor may wait several weeks before adjusting your dose. During this time, continue taking your medication as prescribed even if you don't notice an immediate difference — high blood pressure usually has no symptoms, so you won't necessarily “feel” the effect.
Dizziness is one of the most common side effects of losartan, particularly when you first start taking it or when the dose is increased. To minimise this: rise slowly from sitting or lying positions, avoid standing for long periods, stay well hydrated, and avoid alcohol. If dizziness persists or is severe, or if you feel faint, contact your doctor. They may need to adjust your dose, check your blood pressure, or investigate other causes. Do not drive or operate machinery if you feel dizzy.
NSAIDs such as ibuprofen, diclofenac and naproxen can reduce the effectiveness of losartan and may worsen kidney function, particularly with regular use. Occasional short-term use of NSAIDs is usually acceptable, but you should discuss this with your doctor or pharmacist. Paracetamol (acetaminophen) is generally a safer alternative for pain relief while taking losartan. If you need regular anti-inflammatory medication, your doctor can advise on the safest options and may want to monitor your kidney function and blood pressure more closely.
Yes. Losartan has been used for over 25 years and has an extensive safety record supported by large clinical trials (LIFE, RENAAL) with long-term follow-up. Most patients take losartan for many years or even lifelong as part of their cardiovascular risk management. Long-term benefits include sustained blood pressure control, kidney protection in diabetic patients, and stroke risk reduction. Your doctor will schedule regular check-ups including blood tests (kidney function, potassium levels) and blood pressure monitoring to ensure the medication continues to be safe and effective for you.
References
- Brenner BM, Cooper ME, de Zeeuw D, et al. Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy. N Engl J Med. 2001;345(12):861–869. doi:10.1056/NEJMoa011161 (RENAAL Trial)
- Dahlöf B, Devereux RB, Kjeldsen SE, et al. Cardiovascular morbidity and mortality in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol. Lancet. 2002;359(9311):995–1003. doi:10.1016/S0140-6736(02)08089-3
- European Society of Cardiology/European Society of Hypertension (ESC/ESH). 2023 ESH Guidelines for the management of arterial hypertension. J Hypertens. 2023;41(12):1874–2071. doi:10.1097/HJH.0000000000003480
- KDIGO. KDIGO 2021 Clinical Practice Guideline for the Management of Blood Pressure in Chronic Kidney Disease. Kidney Int. 2021;99(3S):S1–S87. doi:10.1016/j.kint.2020.11.003
- Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure. J Am Coll Cardiol. 2022;79(17):e263–e421. doi:10.1016/j.jacc.2021.12.012
- European Medicines Agency (EMA). Losartan — Summary of Product Characteristics. EMA Assessment Reports. www.ema.europa.eu
- World Health Organization. WHO Model List of Essential Medicines — 23rd List (2023). Geneva: WHO; 2023. who.int
- National Institute for Health and Care Excellence (NICE). Hypertension in adults: diagnosis and management [NG136]. Updated 2022. nice.org.uk/guidance/ng136
- British National Formulary (BNF). Losartan potassium. NICE BNF. bnf.nice.org.uk
- Sica DA, Gehr TW, Ghosh S. Clinical pharmacokinetics of losartan. Clin Pharmacokinet. 2005;44(8):797–814. doi:10.2165/00003088-200544080-00003
Medical Editorial Team
This article was written by the iMedic Medical Editorial Team, comprising licensed physicians specialising in clinical pharmacology, cardiology and nephrology. All medical claims are supported by peer-reviewed evidence and verified against international guidelines from the ESC/ESH, ACC/AHA, KDIGO, EMA, FDA and WHO.
Our editorial process follows the GRADE evidence framework. All factual claims in this article are classified as Evidence Level 1A (systematic reviews and meta-analyses of randomised controlled trials) or Level 1B (individual high-quality RCTs). We have no commercial funding and no conflicts of interest.
Reviewed by: iMedic Medical Review Board
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