Losartan vs lisinopril
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Comparative Analysis of Losartan vs. Lisinopril
Blood Pressure Reduction in Hypertensive Patients
Both losartan and lisinopril are effective in reducing systolic and diastolic blood pressure in patients with mild to moderate hypertension. 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. This makes both drugs viable options for managing hypertension.
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). In contrast, losartan does not significantly affect insulin sensitivity, highlighting a potential advantage of lisinopril for patients concerned with insulin resistance.
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 does not increase ACE2 levels, suggesting a complex interaction between these drugs.
Renal Protection and Proteinuria
In patients with diabetic nephropathy, combination therapy with lisinopril and losartan has been shown to reduce proteinuria more effectively than monotherapy. However, this combination also increases the risk of hyperkalemia and acute kidney injury, leading to the early termination of some studies due to safety concerns . For children with mild IgA nephropathy, lisinopril monotherapy is as effective as combination therapy with losartan, with no significant difference in proteinuria disappearance rates or side effects.
Cough Incidence
Lisinopril is associated with a higher incidence of cough compared to losartan. Patients with a history of ACE inhibitor-induced cough reported significantly fewer cough episodes when treated with losartan . This makes losartan a preferable option for patients who experience cough as a side effect of ACE inhibitors.
Myocardial Perfusion and Cardiomyopathy
Lisinopril improves myocardial perfusion reserve (MPR) and maximal coronary blood flow in patients with hypertension-induced left ventricular hypertrophy (LVH), whereas losartan does not show the same benefit. In the treatment of cardiomyopathy in boys with Duchenne muscular dystrophy, both lisinopril and losartan improve ejection fraction (EF) equally, indicating no significant difference in efficacy between the two drugs for this condition.
Conclusion
Both losartan and lisinopril are effective antihypertensive agents with distinct profiles. Lisinopril offers advantages in improving insulin sensitivity and myocardial perfusion but is associated with a higher incidence of cough and increased ACE2 expression. Losartan, on the other hand, is better tolerated in terms of cough and does not significantly affect insulin sensitivity or ACE2 levels. The choice between these medications should be tailored to the individual patient's needs and medical history, considering the specific benefits and risks associated with each drug.
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