Losartan vs. Lisinopril: What’s the Difference?

Hypertension (high blood pressure, or HBP) is one of the primary catalysts behind stroke and heart disease.

Losartan (brand name: Cozaar) and lisinopril (brand name: Zestril) are first-line antihypertensive drugs that control HBP. However, their class, dosage forms, dosing regimens, and uses differ.

Furthermore, they work in different ways. Losartan is an angiotensin receptor II receptor blocker (ARB) medication that works on specific receptors to provide a therapeutic effect.

Lisinopril is an angiotensin-converting enzyme inhibitor (ACE inhibitor) that inhibits enzyme conversion that raises blood pressure.

Lisinopril is available in tablet and liquid dosage forms, while losartan is available only in tablet form.

This article compares and contrasts losartan versus lisinopril.

Understanding HBP

The risk of stroke increases with HBP (above 115/75 millimeters of mercury [mm Hg]). HBP is a significant risk factor for stroke, associated with 54% of stroke episodes worldwide.

Blood pressure is the force blood pushes against the wall of the arteries.

More specifically, HBP is when the force pushing the blood against the blood vessels’ walls is consistently too high.

HBP increases the workload of the heart and blood vessels, which makes them weaker and work less efficiently. Weak blood vessels can burst or clog more easily.

Consequences

High blood pressure can damage your arteries and lead to various conditions, such as arrhythmia (irregular heartbeat), heart attack (myocardial infarction), and stroke.

A stroke happens when a blood vessel in the brain becomes narrowed or blocked by a clot, preventing adequate blood and oxygen flow to the brain or heart.

Associated Risk Factors

Several risk factors can increase your likelihood of developing high blood pressure, including health conditions like diabetes, lifestyle choices, and family history. However, you can control certain factors to reduce your risk, such as staying physically active, limiting sodium intake, managing weight, and avoiding excessive alcohol and tobacco use.

Medical treatments, including diuretics, beta-blockers, ACE inhibitors, and ARBs, are available by prescription to help manage high blood pressure. Additionally, adopting lifestyle changes can be an effective non-medical strategy to prevent disease progression.

What Is Losartan?

Losartan is a medication known as an angiotensin receptor blocker (ARB). It is approved by the Food and Drug Administration (FDA) for treating high blood pressure (HBP) in adults and children aged 6 years and older.

Losartan is available by prescription in both generic and brand-name forms. It is typically taken as an oral tablet once or twice daily, with or without food, depending on your healthcare provider’s instructions.

Lowering blood pressure reduces the risk of fatal and nonfatal cardiovascular (CV) problems, including stroke and heart attack.

Losartan also reduces the risk of stroke in people with HBP and left ventricular hypertrophy (enlargement of the walls of the left side of the heart).

However, evidence shows it is not beneficial to decrease the risk of stroke for African-Americans.

Losartan is also approved for the treatment of diabetic nephropathy (kidney disease in people who have type 2 diabetes, which results in a lack of blood sugar control) and a history of HBP.

Losartan also reduces the rate of progression of diabetic nephropathy in these people.

Off-Label Uses

Losartan has been used off-label (a use for which the drug was not FDA-approved initially to be used) to treat heart failure (HF, a condition in which the heart cannot pump enough blood to the body).

Brand-Name Association(s)

In addition to Cozaar, other name-brand forms of losartan available include Hyzaar (containing a combination of two active ingredients, hydrochlorothiazide and losartan).

How It Works

Losartan blocks the action of certain natural substances on the receptors (angiotensin II receptors) that work to tighten the blood vessels.

The blockage of receptors reduces the action of these enzymes to improve the blood flow and helps the heart to pump blood more efficiently. 

Losartan controls HBP but does not cure it.

Your blood pressure may start decreasing during the first week of the treatment. It may take three to six weeks to get the full benefit of losartan. 

What Is Lisinopril?

Lisinopril is an ACE inhibitor that is FDA-approved to treat HBP in adults and children 6 years and older.

Lisinopril is also used to reduce signs and symptoms of systolic heart failure (SHF, when the heart’s main chamber pumps blood ineffectively).

Moreover, this drug reduces mortality in people at risk for a heart attack.

Off-Label Uses

Off-label uses for lisinopril include migraine prevention. myocardial fibrosis (MF), and infertility treatment.

Brand-Name Association(s)

Lisinopril is marketed under various brand names.

In addition to Zestril, there exists Qbrelis (lisinopril), and as a combination medicine, Zestoretic (lisinopril and hydrochlorothiazide).

How It Works

Lisinopril works by inhibiting the enzymes (angiotensin-converting enzymes) in the body from making angiotensin II, which works to tighten the blood vessels and increase blood pressure.

The inhibition of these enzymes eases the blood flow and makes the heart pump blood more efficiently.

Dosing Guidelines

The following briefly overviews some standard dosing practices for losartan vs. lisinopril.

Note that neither drug is approved for use in children under 6 years old.

Losrtan

Losartan is available as 25, 50, and 100 milligrams (mg) film-coated tablets.

The dosing regimen for losartan is as follows:

HBP:

• An adult dose is 50 mg once daily.
• The usual dose in children 6 years and older is 0.7 milligrams per kilogram (mg/kg) once daily.

Hypertensive people with LVH:

• The standard starting dose is 50 mg/day.

Nephropathy in type 2 diabetic people:

• The standard dose is 50 mg once daily. However, dosing for this condition may be increased to 100 mg once daily.

Lisinopril

Lisinopril is available as 2.5, 5, 10, 20,30 and 40 mg tablets. It is also available in a 150-milliliter (mL) bottle as an oral solution.

The general dosing regimen for lisinopril is as follows:

HBP:

• The standard dose in adults is 10 mg (as a monotherapy treatment) or 5 mg (on a diuretic) once daily.
• The standard dose in children 6 years and older is 0.07 mg/kg (up to 5 mg total) once daily.

HF: 

• The standard dose is 5 mg once daily. Sometimes, healthcare providers may increase the dose (as tolerated) to 40 mg once daily.

Post-heart attack: 

• The standard dose is 5 mg taken within 24 hours of a heart attack, 5 mg after 24 hours, and 10 mg once daily.

Safe Consumption Guidelines

Take losartan tablet orally once a day with or without food as prescribed. Start taking at a lower dose and gradually increase as required.

Conversely, take a lisinopril tablet or solution (liquid) orally once a day as prescribed. Start taking at a lower dose and gradually increase as required.

When taking liquid dosage form, only use the measuring device (cup or syringe) provided to measure the dose.

Take these medicines as prescribed, and do not increase or change the dose.

Don’t stop taking these drugs without asking your healthcare provider, even if your symptoms improve.

Talk to your healthcare provider before using salt substitutes containing potassium. Take a low-salt or low-sodium diet when taking these medicines.

Which Works Better?

Losartan and lisinopril have been deemed safe and effective options for treating various HBP-related conditions. Furthermore, both drugs have similar levels of efficacy.

To support this, one study compared the effectiveness and safety of lisinopril versus losartan for the treatment of cardiomyopathy (heart disease that harms heart muscle).

The study found no therapeutic difference between lisinopril and losartan over a one-year duration of treatment.

Moreover, the study showed that each drug significantly improved systolic function (cardiac output, which is a product of stroke volume and heart rate) following one year of analysis.

Alternative Treatment Options

HBP is the leading cause of many other vascular disorders.

Antihypertensive medications are an effective way to treat high blood pressure and other associated complications.

However, many non-medical remedies are also proven effective in controlling blood pressure.

The Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure also recommends lifestyle changes for people with HBP.

It recommends reducing sodium intake, increasing exercise, moderating alcohol consumption, losing weight, and following a balanced diet.

Also, as a holistic approach to well-being includes dietary, exercise, and mental health-related pursuits, behavioral therapies such as meditation or deep breathing can also help treat HBP.

Finally, noninvasive procedures, such as acupuncture, have been documented as beneficial in lowering blood pressure to treat HBP and other vascular disorders.

Side Effects & Safety

Like all drugs, losartan and lisinopril carry the potential for side effects upon consumption.

However, these medications come with an FDA warning that neither drug should be used in pregnant people due to potential damage to a developing fetus.

Side effects associated with the use of losartan and lisinopril are listed below.

Common Side Effects

Some common side effects of losartan and lisinopril include:

• Pain in different body parts
• Muscle cramps, tiredness or weakness
• Diarrhea

Drug-Specific Side Effects

In the case of losartan, it may also cause heartburn and decreased sensitivity to touch.

Some other side effects of lisinopril include:

Call your healthcare provider if the symptoms do not go away.

Severe Side Effects

On rare occasions, losartan and lisinopril carry the potential for more severe side effects.

Call your healthcare provider if you have any of the following symptoms:

• Angioedema (swelling of the eyes, face, lips, throat, tongue, hands, feet, ankles, or lower legs)
• Angina (chest pain)
• Difficulty breathing or swallowing

Warnings and Precautions

The use of losartan and lisinopril should be avoided in people with the following:

• Hypersensitivity or history of angioedema to any component of losartan or lisinopril.
• Pregnant people
• Breastfeeding people

Use losartan and lisinopril with caution and monitor carefully for:

Potential for Interaction

Before being prescribed losartan or lisinopril, your healthcare provider will work with you to determine whether you are taking any medications that pose a risk of negative interaction as a byproduct of your current drug regime(s).

Examples of drugs that may negatively interact with losartan or lisinopril include:

Losartan-Specific Interactions

Specific to losartan, the following drugs should not be taken while using losartan:

Lisinopril-Specific Interactions

Specific to lisinopril, the following drugs should not be taken while using lisinopril:

Furthermore, do not take lisinopril if you take other antihypertensive medications, such as Diovan (valsartan) or Entresto (sacubitril), or have stopped taking this type of medication within 36 hours.

Always tell your healthcare provider about all prescription, non-prescription, vitamins, and herbal drugs you take before starting the therapy with these drugs.