Lisinopril vs losartan effectiveness
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Blood Pressure Reduction: Lisinopril vs Losartan Effectiveness
Several studies have compared the effectiveness of lisinopril (an ACE inhibitor) and losartan (an angiotensin receptor blocker) in lowering blood pressure. One study found that lisinopril was more effective than losartan in reducing blood pressure and pulse pressure, especially when measured at home or with ambulatory monitoring, rather than in the clinic setting . Another study showed that both drugs significantly reduced systolic and diastolic blood pressure, but did not find a significant difference between the two in terms of the percentage of patients reaching target blood pressure levels after six months of treatment . Additionally, both drugs were found to be similarly effective in reducing blood pressure in non-diabetic hypertensive patients .
Organ Protection and Special Populations
In patients with Duchenne muscular dystrophy and cardiomyopathy, both lisinopril and losartan led to similar improvements in heart function (measured by ejection fraction) over one year, with no significant difference in effectiveness between the two drugs . In children with mild IgA nephropathy, lisinopril alone was as effective as the combination of lisinopril and losartan in reducing proteinuria, suggesting no added benefit from combining the two drugs in this context . In adults with significant proteinuria, combination therapy with both drugs reduced proteinuria more than losartan alone, but not more than high-dose lisinopril monotherapy 78.
Cognitive Function and Vascular Effects
One study found that losartan improved cognitive function (such as memory and perception) more effectively than lisinopril in older adults with hypertension, even though both drugs improved vascular rigidity and heart structure . Both medications had similar effects on vascular elasticity.
Insulin Sensitivity
Lisinopril was shown to improve insulin sensitivity in non-diabetic hypertensive patients, while losartan did not have a significant effect on insulin sensitivity .
Side Effects: Cough and Safety
A common side effect of ACE inhibitors like lisinopril is dry cough. Studies have shown that patients with a history of ACE inhibitor-induced cough experienced this side effect much less frequently with losartan, with rates similar to placebo 610. Lisinopril was associated with a significantly higher incidence and severity of cough compared to losartan. In animal studies, lisinopril increased the cough reflex, while losartan did not .
Dosing Frequency and Real-World Effectiveness
A large real-world study found no difference in blood pressure control or safety between once-daily and twice-daily dosing of either lisinopril or losartan. However, twice-daily lisinopril was associated with a higher risk of angioedema compared to once-daily dosing .
Conclusion
Lisinopril and losartan are both effective for lowering blood pressure and protecting organs in various patient groups. Lisinopril may be slightly more effective for blood pressure reduction in some settings and can improve insulin sensitivity, but is more likely to cause cough. Losartan may be preferred for patients who experience cough with ACE inhibitors and may offer additional cognitive benefits in older adults. For proteinuria, combination therapy or higher doses may be considered, but safety should be monitored. Overall, the choice between lisinopril and losartan should be individualized based on patient characteristics, side effect profiles, and specific clinical needs.
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