Lisinopril versus losartan
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Comparative Analysis of Lisinopril and Losartan
Blood Pressure Reduction in Hypertensive Patients
Both lisinopril, an ACE inhibitor, and losartan, an angiotensin II receptor blocker (ARB), are effective in reducing systolic and diastolic blood pressure in patients with hypertension. Studies have shown that both medications significantly lower blood pressure, with no significant difference between the two treatments in terms of efficacy 1.
Insulin Sensitivity
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 show a significant effect on insulin sensitivity 1.
ACE2 Expression and COVID-19 Implications
Lisinopril increases tissue levels of ACE2, the receptor for SARS-CoV-2, across various tissues, which could have implications for COVID-19 transmission and pathogenesis. Interestingly, the combination of lisinopril and losartan did not increase ACE2 levels, suggesting an interaction between ACE inhibitors and ARBs in determining tissue ACE2 levels 2.
Proteinuria in IgA Nephropathy
In children with mild IgA nephropathy, lisinopril monotherapy was found to be as effective as combination therapy with losartan in reducing proteinuria. There were no significant differences in the disappearance rate of proteinuria or in the side effects between the two treatment regimens 3.
Cardiomyopathy in Duchenne Muscular Dystrophy
For boys with Duchenne muscular dystrophy-related cardiomyopathy, both lisinopril and losartan were equally effective in improving ejection fraction over a one-year period. There was no significant difference in therapeutic outcomes between the two drugs 4.
Cough Incidence
Lisinopril is associated with a higher incidence of cough compared to losartan. Patients with a history of ACE inhibitor-related cough experienced significantly fewer cough episodes when treated with losartan. This makes losartan a preferable option for patients who develop cough with ACE inhibitors 56810.
Myocardial Perfusion Reserve
Lisinopril has been shown to improve myocardial perfusion reserve (MPR) in patients with hypertension and left ventricular hypertrophy, likely due to its effect on bradykinins. Losartan, which lacks this effect on bradykinins, did not show a similar improvement in MPR 9.
Dosing Frequency and Safety
There is no significant difference in blood pressure control between once-daily and twice-daily dosing of either lisinopril or losartan. However, twice-daily dosing of lisinopril was associated with an increased risk of angioedema compared to once-daily dosing 7.
Conclusion
Both lisinopril and losartan are effective antihypertensive agents with distinct profiles. Lisinopril improves insulin sensitivity and myocardial perfusion reserve but has a higher incidence of cough and potential for increased ACE2 expression. Losartan, on the other hand, is better tolerated in terms of cough and does not affect insulin sensitivity or myocardial perfusion reserve. The choice between these medications should be tailored to the individual patient's needs and medical history.
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Most relevant research papers on this topic
Comparative effects of lisinopril and losartan on insulin sensitivity in the treatment of non diabetic hypertensive patients.
Lisinopril improved insulin sensitivity in non diabetic hypertensive patients, while losartan did not show a significant effect on it.
RCTOral Lisinopril Raises Tissue Levels of ACE2, the SARS-CoV-2 Receptor, in Healthy Male and Female Mice
Oral lisinopril increases ACE2 in tissues relevant to COVID-19 transmission and pathogenesis, but the addition of losartan prevents these increases in ACE2 levels.
RCT
Animal StudyLisinopril versus lisinopril and losartan for mild childhood IgA nephropathy: a randomized controlled trial (JSKDC01 study)
Lisinopril monotherapy is effective and safe for children with mild IgA nephropathy, as there are no advantages of combination therapy compared to lisinopril and losartan.
RCT
Rigorous JournalA Randomized, Double-Blind Trial of Lisinopril and Losartan for the Treatment of Cardiomyopathy in Duchenne Muscular Dystrophy
Lisinopril and losartan show no therapeutic difference in ejection fraction improvement over a one-year period for treating cardiomyopathy in boys with Duchenne muscular dystrophy-related cardiomyopathy.
RCT
Highly CitedEffects of modulators of the renin—angiotensin—aldosterone system on cough
Losartan has a significantly lower incidence of cough-related side effects compared to lisinopril and hydrochlorothiazide, making it a potential new treatment for hypertensive patients with ACE inhibitor-related cough.
RCTHighly CitedComparison between the effects of lisinopril and losartan on the cougn reflex in anesthetized and awake rabbits.
Lisinopril, but not losartan, increases the cough reflex in anesthetized and awake rabbits, while both drugs have similar hypotensive effects.
RCTAnimal StudyTwice-daily versus once-daily lisinopril and losartan for hypertension: Real-world effectiveness and safety
Twice-daily lisinopril and losartan do not show improved effectiveness or safety compared to once-daily doses, with increased odds of angioedema.
Observational StudyRigorous JournalDouble-blind comparison of losartan, lisinopril and hydrochlorothiazide in hypertensive patients with a previous angiotensin converting enzyme inhibitor-associated cough
Losartan does not cause cough in patients with previous angiotensin converting enzyme inhibitor cough, suggesting its potential as a safe alternative treatment for hypertension.
RCTAugmentation of myocardial blood flow in hypertensive heart disease by angiotensin antagonists: a comparison of lisinopril and losartan.
Lisinopril improves myocardial perfusion reserve and maximal coronary flow in patients with hypertension-induced left ventricular hypertrophy, while losartan shows no significant improvement.
Non-RCTUse of losartan in the treatment of hypertensive patients with a history of cough induced by angiotensin-converting enzyme inhibitors.
Losartan significantly reduces the incidence, severity, and frequency of dry cough in hypertensive patients with a history of ACE inhibitor-induced dry cough compared to lisinopril and placebo.
RCT