Comparison of losartan and lisinopril
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Blood Pressure Control: Lisinopril vs. Losartan in Hypertension
Both lisinopril (an ACE inhibitor) and losartan (an angiotensin receptor blocker) are effective in lowering blood pressure in patients with mild to moderate hypertension. Studies show that both drugs significantly reduce systolic and diastolic blood pressure, with no major difference in the degree of blood pressure reduction between the two treatments 14.
Insulin Sensitivity and Metabolic Effects
Lisinopril has been shown to improve insulin sensitivity in non-diabetic hypertensive patients, as measured by glucose infusion rate and total glucose requirement. Losartan, on the other hand, did not significantly affect insulin sensitivity in the same population .
Myocardial Perfusion and Cardiac Effects
In patients with hypertension and left ventricular hypertrophy, lisinopril improved myocardial perfusion reserve and maximal coronary blood flow, while losartan did not show significant changes in these parameters. This suggests that lisinopril may be more effective in repairing coronary microangiopathy associated with hypertension-induced heart changes . However, in boys with Duchenne muscular dystrophy and cardiomyopathy, both lisinopril and losartan led to similar improvements in ejection fraction over one year, indicating comparable effectiveness for this specific cardiac condition .
Proteinuria and Kidney Protection
Both lisinopril and losartan are effective in reducing proteinuria and microalbuminuria, which are important markers of kidney damage, especially in patients with diabetes or chronic kidney disease. Studies in type 2 diabetes mellitus show that both drugs significantly reduce microalbuminuria, with no statistically significant difference in efficacy between them 56. Dose titration and combination therapy can further enhance the antiproteinuric effect, but safety considerations remain important .
Antihypertensive Effect Duration and Consistency
Lisinopril provides a more consistent antihypertensive effect throughout the day, as indicated by higher trough:peak ratios and morning:evening blood pressure ratios compared to losartan. However, both drugs can achieve similar overall smoothness in blood pressure control among responders .
Cough and Side Effect Profile
Lisinopril is associated with a higher incidence of cough compared to losartan. In patients with a history of ACE inhibitor-induced cough, losartan has a much lower risk of causing cough, similar to that of a diuretic (hydrochlorothiazide), while lisinopril frequently induces cough 7810. Animal studies also confirm that lisinopril increases cough reflex sensitivity more than losartan .
Effects on ACE2 Expression
Lisinopril increases tissue levels of ACE2, the receptor for SARS-CoV-2, in animal studies, while losartan does not. Interestingly, combining the two drugs prevents the lisinopril-induced increase in ACE2 . The clinical significance of this finding, especially in the context of COVID-19, is still being explored.
Conclusion
Lisinopril and losartan are both effective antihypertensive agents with similar efficacy in blood pressure reduction and kidney protection. Lisinopril may offer additional benefits in improving insulin sensitivity and myocardial perfusion but is more likely to cause cough. Losartan is preferred for patients who experience cough with ACE inhibitors. Both drugs are valuable options, and the choice may depend on individual patient characteristics and side effect profiles.
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