Losartan lisinopril
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Summary
10 papers analyzed
Some studies suggest that losartan is less likely to cause cough and may be safer for patients with ACE inhibitor-related cough, while other studies indicate that lisinopril improves insulin sensitivity and increases ACE2 levels relevant to COVID-19, but both drugs can increase the risk of adverse events when combined.
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Comparative Analysis of Losartan and Lisinopril: Efficacy, Side Effects, and Clinical Implications
Blood Pressure Reduction in Hypertensive Patients
Both losartan, an angiotensin II receptor antagonist, and lisinopril, an ACE inhibitor, are effective in reducing systolic and diastolic blood pressure in hypertensive patients. Studies have shown that both medications significantly lower blood pressure, with no substantial difference in their efficacy in this regard.
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 does not significantly affect insulin sensitivity.
ACE2 Expression and COVID-19 Implications
Lisinopril increases tissue levels of ACE2, the receptor for SARS-CoV-2, across various tissues, including the lung, kidney, and small intestine. This increase persists even after cessation of the drug. Interestingly, the combination of lisinopril and losartan does not elevate ACE2 levels, suggesting a complex interaction between these medications.
Cough Incidence
A common side effect of ACE inhibitors like lisinopril is a persistent dry cough, which is significantly less common with losartan. Studies have consistently shown that patients with a history of ACE inhibitor-induced cough experience a much lower incidence of cough when switched to losartan . This makes losartan a preferable option for patients who develop this side effect with ACE inhibitors.
Diabetic Nephropathy and Proteinuria
In patients with diabetic nephropathy, combination therapy with losartan and lisinopril has been explored for its potential to reduce proteinuria. However, this combination increases the risk of adverse events such as hyperkalemia and acute kidney injury without providing significant benefits over monotherapy . Therefore, while dual blockade of the renin-angiotensin system may reduce proteinuria more effectively, it poses significant safety concerns.
Conclusion
Both losartan and lisinopril are effective antihypertensive agents with distinct profiles. Lisinopril improves insulin sensitivity and increases ACE2 expression, which has implications for COVID-19. However, it is associated with a higher incidence of cough. Losartan, on the other hand, is less likely to cause cough and is safer in combination therapies for diabetic nephropathy, although it does not improve insulin sensitivity. Clinicians should consider these differences when prescribing these medications, tailoring treatment to the individual needs and risk profiles of their patients.
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