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About Domenic Sica
Expertise
All aspects of hypertension as well as any consideration in drug therapy for the management of hypertension.

Experience
Heavily published in the area of drug therapy in hypertension and renal disease. Primary management physician for a large multi-state referral practice for diagnosis and management of complex hypertension

Organizations
Multiple including the American Society of Hypertension, International Society of Hypertension, American Society of Nephrology, American Heart Association, American College of Clinical Pharmacology amongst others.

Publications
Over 250 publications (see PubMed)

Education/Credentials
Board certified in internal medicine, nephrology, clinical pharmacology, and hypertension

Awards and Honors
Multiple awards as clinical and/or teacher of the year.

Past/Present Clients
Not pertinent

You are here: Experts > Health/Fitness > Diabetes > Hypertension > Switching from Lisinopril to Cozaar

Hypertension - Switching from Lisinopril to Cozaar

Expert: Domenic Sica - 10/24/2009

Question
QUESTION: Hey there,
I'm a 34 yr old male with hbp. Don't know why I have it. I've been on meds for 15 years. I currently take 25 mg of atenolol 1.5 times daily. And 20 mg of Lisinopril 1 time daily.
I check my bp at home once a week and it avg about 127/67 (It can range from about 117 - 140/60 - 80).
I have a bicuspid aortic valve (no problems with it so far) so I see a cardiologist every year. I had an appointment today with my new cardiologist and he suggested switching from Lisinopril to Cozaar. My bp was a bit elevated in the office (2 readings 136/90 and 131/82) and he thought since my bp avgs were systolic numbers were still not below 120, to try a switch. Plus he said that Cozaar had the added benefit of protecting the Aorta from enlarging (he mentioned some studies).
I'm interested in switching for the added protection of my aorta, but I have some reservations because I'm not sure why the need to switch if my bp numbers have been pretty good. I've been taking the same meds for years and I worry that changing things up is gonna throw my body out of whack.
Is Cozaar a better drug in your opinion? Why would some patients be prescribed Lisinopril and not Cozaar if Cozaar is so much better? (I know Cozaar is more expensive so maybe that's the reason?)

Thanks for your expertise.

ANSWER: No, Cozaar is not a better drug and it would not reduce your blood pressure any better than lisinopril. It It does not sound like your aorta is enlarging any more than the next person with hypertension so I confused as to why your physician would be trying to "protect" your aorta with what is a considerably more expensive medication.

Regards,

Domenic Sica, M.D.

---------- FOLLOW-UP ----------

QUESTION: Thanks for your response, Doctor. That's interesting.
This was just a consultation, but he was not concerned by any of my previous echo results (my aortic root has measured 3.2 and 2.8 in my last two echos, with trivial regurgitation of the valve - and I'm 6'3"). He just mentioned that for BAV patients, it's important to be aggressive with bp treatment and try and get that systolic below 120 and that over time, BAV patients tend to have enlargement of the aorta.
Like I mentioned, Cozaar has shown results that protect against enlargement whereas Lisinopril has not been tested for that kindof thing (the doc's words).
But in your mind, the only meaningful difference is the price?
If that's the case, I may try and press him as to why he thinks it worth the switch.
thanks

Answer
The studies he is speaking to relate to the use of losartan in a mouse model of a genetic disease called Marfan's syndrome. There are no studies in patients with bicupid aortic value in whom one is trying to prevent some possible future dilation of the aorta. If the issue is more blood pressure reduction and his preference is that your systolic blood pressure should be less than 120 mm Hg (I don ot believe there is any published data to support that low a blood pressure) then the addition of a low-dose of a diuretic would be much more likely to reduce blood pressure further than would a switch from lisinopril to losartan.

Regards,

Dom Sica, M.D.

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