Losartan lisinopril equivalent
Pro Research Analysisby 
Searched over 200M research papers
Losartan and Lisinopril: Comparative Analysis and Equivalence
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 interfering with the renin-angiotensin-aldosterone system (RAAS), albeit through different mechanisms.
Blood Pressure Reduction Efficacy
Both losartan and lisinopril have been shown to effectively reduce systolic and diastolic blood pressure in patients with hypertension. A study comparing the two drugs found that both significantly reduced systolic blood pressure (SBP) by approximately 20.2 mmHg for lisinopril and 17.2 mmHg for losartan, and diastolic blood pressure (DBP) by 15.2 mmHg and 12.3 mmHg, respectively, with no significant difference between the two treatments.
Insulin Sensitivity
Lisinopril has been found to improve insulin sensitivity, 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 offer additional metabolic benefits in hypertensive patients.
Cardiomyopathy in Duchenne Muscular Dystrophy
In a study involving boys with Duchenne muscular dystrophy (DMD) and cardiomyopathy, both lisinopril and losartan were found to improve ejection fraction (EF) equally over a one-year period. This indicates that both drugs are similarly effective in managing cardiomyopathy in DMD patients.
Myocardial Perfusion Reserve
Lisinopril has been shown to improve myocardial perfusion reserve (MPR) and maximal coronary blood flow in patients with hypertension and left ventricular hypertrophy (LVH). Losartan, however, did not show a significant effect on MPR or coronary blood flow in the same patient population. This suggests that lisinopril may be more beneficial for patients with hypertension-induced LVH.
Cough Reflex and Tolerability
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.
Combination Therapy and Safety
Combining lisinopril with losartan in patients with type 2 diabetes and proteinuria increased the risk of hyperkalemia and acute kidney injury without providing additional benefits in reducing the progression of proteinuric diabetic nephropathy. This highlights the need for caution when considering combination therapy involving these two drugs.
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 lung, kidney, and small intestine. Interestingly, the combination of lisinopril and losartan did not increase ACE2 levels, suggesting a complex interaction between these drugs in regulating ACE2 expression.
Conclusion
Both losartan and lisinopril are effective antihypertensive agents with unique benefits and side effect profiles. Lisinopril may offer additional metabolic and myocardial perfusion benefits but is associated with a higher incidence of cough. Losartan, on the other hand, is better tolerated in terms of cough and is equally effective in improving cardiac function in specific conditions like DMD-related cardiomyopathy. However, combination therapy with these drugs should be approached with caution due to the increased risk of adverse renal outcomes.
Sources and full results
Most relevant research papers on this topic