Losartan lisinopril conversion
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Conversion Between Losartan and Lisinopril: A Comparative Analysis
Introduction to Losartan and Lisinopril
Losartan and lisinopril are commonly prescribed medications for managing hypertension and related cardiovascular conditions. Losartan is an angiotensin II receptor blocker (ARB), while lisinopril is an angiotensin-converting enzyme (ACE) inhibitor. Both drugs function by modulating the renin-angiotensin-aldosterone system (RAAS), but they do so through different mechanisms. This article explores the comparative effects of these medications, particularly focusing on their impact on insulin sensitivity, renal function, and cardiovascular health.
Blood Pressure and Insulin Sensitivity
Blood Pressure Reduction
Both losartan and lisinopril are effective in reducing systolic and diastolic blood pressure. Studies have shown that both medications significantly lower systolic blood pressure (SBP) and diastolic blood pressure (DBP) with no significant difference between the two treatments .
Insulin Sensitivity
Lisinopril has been found to improve insulin sensitivity significantly, as indicated by an increase in glucose infusion rate (GIR) and total glucose requirement (TGR) during euglycemic hyperinsulinemic clamp tests. In contrast, losartan does not significantly affect insulin sensitivity. This suggests that lisinopril may be more beneficial for hypertensive patients who are also managing insulin resistance or prediabetes.
Renal Function and Angiotensin Metabolism
Renal Angiotensin-(1-7) Formation
Both losartan and lisinopril increase the activity of ACE2, an enzyme that converts angiotensin II to angiotensin-(1-7), a peptide with vasodilatory and antitrophic properties. This increase in ACE2 activity is observed in the renal cortex, indicating enhanced intrarenal formation of angiotensin-(1-7) . However, combination therapy with both drugs does not further increase ACE2 activity beyond what is achieved with either drug alone.
Proteinuria and Diabetic Nephropathy
In patients with type 2 diabetes and proteinuria, combination therapy with losartan and lisinopril has been shown to decrease proteinuria but also increases the risk of hyperkalemia and acute kidney injury. This combination therapy does not significantly reduce the progression of kidney disease compared to monotherapy with losartan . Therefore, while combination therapy may offer some benefits in reducing proteinuria, it also poses significant risks.
Cardiovascular Health and Tissue ACE2 Levels
Cardiomyopathy in Duchenne Muscular Dystrophy
A study comparing the effectiveness of lisinopril and losartan in treating cardiomyopathy in boys with Duchenne muscular dystrophy found no significant difference between the two drugs in improving ejection fraction (EF) over one year. Both medications were equally effective in managing cardiomyopathy in this patient population.
ACE2 Expression and COVID-19 Implications
Lisinopril has been shown to increase tissue levels of ACE2, the cellular receptor for SARS-CoV-2, across various tissues including the lung, kidney, and small intestine. This increase in ACE2 levels is not observed when losartan is added to lisinopril therapy, suggesting that losartan may counteract the ACE2-raising effect of lisinopril. This finding has implications for the management of hypertensive patients during the COVID-19 pandemic, as increased ACE2 levels could potentially influence viral entry and infection severity.
Side Effects and Tolerability
Cough Incidence
Lisinopril is associated with a higher incidence of cough compared to losartan. In patients with a history of ACE inhibitor-related cough, losartan is a preferable alternative as it does not induce cough to the same extent as lisinopril .
Hyperkalemia and Acute Kidney Injury
Combination therapy with losartan and lisinopril increases the risk of hyperkalemia and acute kidney injury compared to monotherapy. This increased risk necessitates careful monitoring of patients on combination therapy, particularly those with underlying renal impairment or diabetes .
Conclusion
Both losartan and lisinopril are effective antihypertensive agents with distinct profiles. Lisinopril improves insulin sensitivity and increases tissue ACE2 levels, while losartan is less likely to cause cough and does not significantly affect insulin sensitivity. Combination therapy offers some benefits in reducing proteinuria but comes with increased risks of hyperkalemia and acute kidney injury. Clinicians should consider these differences when choosing between these medications for individual patients, particularly those with comorbid conditions such as diabetes or chronic kidney disease.
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