Lisinopril equivalent to losartan
Pro Research Analysisby 
Searched over 200M research papers
Consensus Meter
Comparative Analysis of Lisinopril and Losartan: Efficacy, Safety, and Side Effects
Blood Pressure Reduction in Hypertensive Patients
Both lisinopril, an ACE inhibitor, and losartan, an angiotensin II receptor blocker (ARB), are effective in reducing blood pressure in patients with hypertension. Studies have shown that both medications significantly lower systolic and diastolic blood pressure, with no significant difference in the extent of blood pressure reduction between the two drugs . This indicates that both medications are equally effective in managing hypertension.
Insulin Sensitivity and Metabolic Effects
Lisinopril has been found to improve insulin sensitivity in non-diabetic hypertensive patients, as indicated by an increase in glucose infusion rate (GIR) and total glucose requirement (TGR) during euglycemic hyperinsulinemic clamp tests. In contrast, losartan did not significantly affect insulin sensitivity. This suggests that lisinopril may have additional metabolic benefits over losartan in terms of improving insulin sensitivity.
Cardiomyopathy in Duchenne Muscular Dystrophy
In the treatment of cardiomyopathy in boys with Duchenne muscular dystrophy (DMD), both lisinopril and losartan have been shown to improve ejection fraction (EF) equally over a one-year period. There was no significant difference in the therapeutic efficacy between the two drugs for this condition. This suggests that either medication can be effectively used for managing cardiomyopathy in DMD patients.
ACE2 Expression and COVID-19 Implications
Lisinopril has been shown to increase tissue levels of ACE2, the receptor for SARS-CoV-2, in various tissues including the small intestine, lung, kidney, and brain. Interestingly, the combination of lisinopril and losartan did not increase ACE2 levels and even decreased ACE2 gene expression in some tissues. This finding is particularly relevant in the context of COVID-19, as increased ACE2 expression could potentially influence the susceptibility to the virus.
Combination Therapy for Hypertension
Adding losartan to lisinopril therapy in patients whose hypertension is not controlled by lisinopril alone has been found to produce a greater reduction in both ambulatory and casual blood pressure compared to doubling the dose of lisinopril. This combination therapy also resulted in increased plasma renin activity (PRA) and angiotensin I (Ang I) levels, suggesting a more complete blockade of the renin-angiotensin system (RAS). However, combination therapy with ACE inhibitors and ARBs in diabetic nephropathy patients has been associated with increased risks of hyperkalemia and acute kidney injury, indicating the need for careful monitoring.
Cough Incidence
Lisinopril is associated with a higher incidence of cough compared to losartan. Studies have shown that patients with a history of ACE inhibitor-related cough experienced significantly fewer cough episodes when switched to losartan . This makes losartan a preferable option for patients who develop a cough with ACE inhibitors.
Myocardial Perfusion Reserve
In patients with hypertension and left ventricular hypertrophy (LVH), lisinopril has been shown to improve myocardial perfusion reserve (MPR) and maximal coronary blood flow, whereas losartan did not show such improvements. This suggests that lisinopril may be more effective in addressing coronary microangiopathy associated with hypertension-induced LVH.
Dosing Frequency and Safety
A study comparing twice-daily (BID) versus once-daily (QDay) dosing of lisinopril and losartan found no significant differences in blood pressure control between the two dosing regimens. However, BID dosing of lisinopril was associated with an increased risk of angioedema compared to QDay dosing. This highlights the importance of considering dosing frequency and potential side effects when prescribing these medications.
Conclusion
Both lisinopril and losartan are effective in managing hypertension, with some differences in their metabolic effects, side effect profiles, and specific clinical applications. Lisinopril may offer additional benefits in improving insulin sensitivity and myocardial perfusion reserve but is associated with a higher incidence of cough. Losartan, on the other hand, is less likely to cause cough and can be effectively combined with lisinopril for enhanced blood pressure control. Careful consideration of patient-specific factors and potential side effects is essential in choosing the appropriate medication.
Sources and full results
Most relevant research papers on this topic