Lisinopril vs Losartan Which is better?

Dr.John Thurairajah

December 12, 2021

Lisinopril vs Losartan Which is better?

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Losartan and Lisinopril are both medication used to treat high blood pressure and some heart problems.

Common questions asked are: What is the difference between these 2 medications and which medication should I use? Let’s find out, NEXT!

What are Lisinopril and Losartan?

Lisinopril belongs to a group of medicines known as angiotensin-converting enzyme inhibitors. They are also called ACE inhibitors. The brand names are Prinivil and Zestril.

On the other hand Losartan belongs to a family of medications called an angiotensin II receptor blocker (ARBS for short). The brand name is (Cozaar).

How do Lisinopril and Losartan work?

Both Lisinopril and Losartan are able to work on a part of your body called the renin-angiotensin system. However, they go about this in different ways. Lisinopril blocks angiotensin converting enzyme thus preventing a substance called angiotensin two from being made, while Losartan prevents angiotensin two from binding to angiotensin receptors in the first place.

The result is the same: they both relax and widen blood vessels. This lowers your blood pressure and makes it easier for your heart to pump blood around your body.

Which medication is better for you?

Well that would depend on your co-morbidities and what else your health care provider is going to treat.

Both can be used to treat high blood pressure. Both can be used in the treatment of heart failure. Lisinopril can also be used after a heart attack to improve survival. Whereas Losartan can be used with individuals with left ventricular hypertrophy, which just a fancy way of saying that your left chamber of your heart is thicker. In this way Losartan can be used with patients who have high blood pressure and LVH to prevent strokes. The added additional bonus with Losartan is that it can be given to patients who are diabetic, to protect your kidney function, especially if you are losing protein through your kidney.

How are Losartan and Lisinopril taken?

Both can be taken by mouth with or without food and the doses for Lisinopril range from 5 to 40mg daily .The ranges for Losartan range from 25mg to 100mg daily. Both medications are typically daily. The 100mg dose for losartan can be split into two 50mg doses.

How effective are Lisinopril and Losartan for blood pressure control?

According to the Annals of Internal Medicine, a peer review medical journal concluded:

“Available evidence shows that ACE inhibitors and ARBs have similar effects on blood pressure control, and that ACE inhibitors have higher rates of cough than ARBs. Data regarding other outcomes are limited”.

What about side effects for Lisinopril and Losartan?

Both medications do share similar side effects as they work in similar ways in your body. If you are interested in a bit more detailed look at Lisinopril and side effects click right here.

In this article I will only touch on some common side effects and differences.

The first thing to mention is the Lisinopril cough. This is not dose dependent meaning you can a cough at lower doses, and you can have it at higher doses. Moreover, the onset of the cough can be delayed. Typically, we associate this cough in the first weeks of treatment, but you can develop this cough even several years after initiation of treatment. According to UptoDate.com “literature suggests incidence may be as high as 20%.”This cough is typically a dry cough described by patients as a scratching or tickling sensation at the back of one’s throat. Losartan on the other hand is less likely to cause a cough and according to UptoDate.com the incidence is at 3%.
Both Lisinopril and Losartan can cause an increased potassium. Why should you be concerned? Side effects of a high potassium are: feeling nauseous, chest pain, weakness, irregular heartbeat, unsteady on your feet. If you are on these medications avoid extra potassium from your food or supplements. Your health care provider or pharmacist can give you appropriate advice regarding this.
Both drugs in some individuals can cause kidney problems. This can become a problem if your blood volume is compromised because you are dehydrated or you are on a diuretic. Your health care provider should monitor your renal parameters regularly.
Both drugs should not be used during pregnancy as they can cause birth defects.
Both drugs, especially in the first few weeks of therapy can when changing position from lying to sitting or sitting to standing make you feel dizzy. Always take your time when standing up. You don’t want to stand up too quickly and fall down and hurt yourself, and worse yet break your bone.
Both drugs can cause a rare side effect called angioedema. In this situation your face, lips, tongue and throat swell up. This is an emergency situation and go to the nearest Hospital ASAP.

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My blood pressure is high, can I combine both drugs?

Both drugs when taken together increase the chance of side effects. This combination of drugs is associated with an increased risk of high potassium and acute kidney injury.

Ethnic differences and adverse events:

I should mention that Losartan may be not as effective if you are of African American descent. This is because of lower levels of a hormone called renin while your blood pressure is elevated.

Another difference is that Losartan compared to Lisinopril is less likely to cause a gout attack.

Chinese Americans are more than twice as likely to experience a cough with Lisinopril compared to the general population. Moreover, individuals of African descent were at increased risk for angioedema. Are you on one of these medications and have you experienced a side effect?

Losartan recall( ca 2019):

In 2019 & subsequent years there have been recalls of Losartan and other ARBS due to trace amounts of impurities in an active pharmaceutical ingredient. These recalls affected certain lot and batch numbers. The names of these impurities are NDMA& NDEA. They are also referred to as Nitrosamines. There is the risk of cancer if taken for a long period of time. Currently the FDA is recommending that you should continue taking the medication. If the medication were to be suddenly stopped the harm would be higher to someone’s health without an alternative treatment. You can talk to your Doctor or Pharmacist to safely switch to an alternate ARB or lot which was not affected.

To sum it up, both Lisinopril and Losartan are similar but can be used for different health conditions. Losartan is less likely to cause that dry cough as well as facial swelling mentioned earlier in this article.

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