Lisinopril vs. Losartan: Which Is Better for High Blood Pressure?

February 8, 2025/Andrew Le

High blood pressure is a big problem that affects 119 million people. It can lead to heart disease and stroke, which are very dangerous. 

Lisinopril and Losartan are two medicines that help lower blood pressure, but they work differently. 

In this article, you will discover how each medicine works, its benefits, possible side effects, and how losartan and lisinopril are different. This will help you make a smart choice for your health.

🔑Key Takeaways

➤ You can use either Lisinopril or Losartan to lower your high blood pressure.

➤ Lisinopril might make you cough, but Losartan usually doesn’t have that side effect. This can help you choose the right one for you.

➤ You take Lisinopril once daily, and it keeps working all day. This means you don’t have to remember to take it many times a day.

➤ Both medicines can have side effects. If you feel sick or notice swelling, tell your doctor immediately.

➤ Lisinopril is often cheaper than Losartan, but the price can change depending on where you buy it. Check with your pharmacy for the best deal.

➤ Your doctor will decide which medicine is better for you based on your health and needs. Make sure to talk to them about any other medicines you take.

➤ Using a discount card like Drugs.com can save you money on Lisinopril and Losartan. Ask your pharmacist how to get one.

Mechanisms of Action 

Let’s explore how Lisinopril and Losartan help control blood pressure.

Lisinopril 

Lisinopril blocks the angiotensin-converting enzyme or ACE. This stops angiotensin I from turning into angiotensin II, a substance that tightens blood vessels. With less angiotensin II, aldosterone secretion decreases. This means your kidneys reabsorb less sodium and release less potassium. You might notice a small rise in your blood potassium levels.

Lisinopril also increases renin activity in your blood by blocking angiotensin II’s feedback loop. This helps control high blood pressure by shutting down the renin-angiotensin-aldosterone system. It reduces substances that narrow blood vessels and release aldosterone, even if renin levels are low. 

However, ACE inhibitors like lisinopril can break down bradykinin, which may raise the risk of swelling called angioedema.

🤔 Did You Know?

Lisinopril takes some time to lower your blood pressure, but its effects last all day. It begins to work within 2 hours, peaks around 6 hours and stays effective for at least 24 hours. It reduces the top and bottom numbers of your blood pressure while keeping blood flow to your kidneys stable. Additionally, it doesn’t significantly change your heart rate or other heart functions.

Losartan

Losartan is a type of drug called an angiotensin II receptor blocker, or ARB. It specifically targets the AT1 receptor. By blocking this receptor, losartan causes your body to produce more renin and angiotensin I. It binds to the AT1 receptor very tightly—over 10,000 times more than to the AT2 receptor. This precise action stops angiotensin II from narrowing your blood vessels, helping to manage high blood pressure and related conditions.

When losartan blocks angiotensin II, it stops several reactions in your body. It lowers vasopressin release, reduces adrenal catecholamines, and calms the sympathetic nervous system. It also makes you less thirsty and prevents abnormal cell growth. These actions help lower your blood pressure and reduce the strain on your heart and blood vessels.

Losartan also stops angiotensin II from tightening blood vessels and releasing aldosterone. This helps your body manage sodium and fluids better. As a result, you excrete more:

  • Sodium
  • Potassium
  • Chloride
  • Magnesium
  • Uric acid
  • Calcium
  • Phosphate in your urine

Removing these extra fluids and minerals helps lower your blood pressure even more. Unlike ACE inhibitors, losartan and other ARBs block the renin-angiotensin system without changing bradykinin levels. This reduces the chances of side effects like coughing and swelling, which are more common with ACE inhibitors.

Indications and Uses

Here’s how Lisinopril and Losartan are used to manage high blood pressure and other related conditions.

Lisinopril 

PopulationInitial DoseMaximum DoseNotesUses
Adults (High blood pressure)10 mg or 5 mg once daily80 mg once dailyStart with 5 mg if on diuretic; 80 mg dose does not provide additional effect.Treatment of high blood pressure
Geriatrics (High blood pressure)2.5 to 5 mg once daily40 mg once dailyIncrease by 2.5 to 5 mg per day at 1-2 week intervals. Gradual titration is recommended.Treatment of high blood pressure
Pediatrics (6+ years)0.07 mg/kg once daily (up to 5 mg)0.61 mg/kg once daily (up to 40 mg)Adjust dose based on BP response at 1-2 week intervals; not recommended for GFR <30 mL/min or age <6 years.Treatment of high blood pressure

You can usually start with 2.5 mg to 10 mg each day. Your doctor might increase the dose to 20 mg or even up to 80 mg daily. This works well for older adults, even those with low-renin essential high blood pressure. 

In one study about the efficacy and safety of lisinopril with 97 older and 710 younger patients, doses were adjusted to keep diastolic pressure below 90 mm Hg or up to 80 mg a day. Older adults had the same or better blood pressure control as younger ones and tolerated the medicine well.

In a study with 115 children aged 6 to 16, an initial dose of 0.07 mg/kg lowered blood pressure in two weeks. Higher doses led to greater reductions in blood pressure. When children stopped taking lisinopril, their blood pressure went back up, showing the medicine works well long-term.

Losartan

PopulationInitial DoseMaximum DoseNotesUses
Adults (High blood pressure)50 mg once daily100 mg once dailyIncrease to 100 mg if needed; effect seen within 1-6 weeksTreatment of high blood pressure, stroke risk reduction, diabetic nephropathy
Pediatrics (6+ years)0.7 mg/kg once daily (up to 50 mg)1.4 mg/kg once daily (up to 100 mg)Can be given as tablet or suspension; higher doses not studiedTreatment of high blood pressure

Losartan comes in tablets of 25 mg, 50 mg, and 100 mg. The right dose depends on what you’re treating. If you’re an adult with high blood pressure, doctors usually start you on 50 mg once a day. They might increase it to 100 mg daily if needed. A study showed that 50 mg of losartan significantly lowered blood pressure. After eight weeks, the diastolic pressure dropped by 13 mm Hg. Taking more than 50 mg, like 100 mg or 150 mg, didn’t provide extra benefits but kept blood pressure steady all day.

For kids six years and older, the starting dose is 0.7 mg per kilogram of body weight each day, up to 50 mg. Higher doses haven’t been tested in children. In a study, losartan given at 0.75 mg/kg (max 50 mg) effectively lowered diastolic blood pressure in kids aged 6 to 16 within three weeks. The blood pressure reduction depended on the dose. The middle dose group (25/50 mg) saw an 11.7 mm Hg drop in diastolic pressure. Losartan is usually well tolerated in kids, even up to 1.44 mg/kg daily (max 100 mg).

Effectiveness for High Blood Pressure

Let’s explore how Lisinopril and Losartan perform in controlling high blood pressure.

Lisinopril 

Lisinopril is a medicine you can take once a day to help lower your blood pressure. Studies show that 68% to 89% of older patients reached a diastolic blood pressure of 90 mm Hg or less after using Lisinopril for at least eight weeks. 

Another 12-week study compared Lisinopril (40–80 mg daily) to Metoprolol (100–200 mg daily). After four weeks, patients on Lisinopril had their systolic blood pressure drop by an average of 18 mm Hg. This was more than the 12 mm Hg drop seen with Metoprolol. Both medicines lowered diastolic blood pressure, but there was no significant difference between them. 

Losartan

Losartan has also proven effective through clinical studies. In one study, researchers compared losartan doses of 50 to 150 mg to 20 mg of enalapril and a placebo in patients with mild to moderate high blood pressure. Losartan significantly lowered both systolic and diastolic blood pressure compared to the placebo. The 50 mg dose worked as well as 20 mg of enalapril. Doses of 50 mg and higher consistently reduced diastolic blood pressure, making Losartan a reliable once-daily option.

In another study, Losartan was tested in patients who couldn’t tolerate calcium channel blockers or ACE inhibitors. Taking 50 mg daily significantly lowered blood pressure within 30 days and kept it down for six months. It didn’t affect heart rate, and patients experienced few side effects with stable health results.

Side Effects

When you take Lisinopril or Losartan, knowing the possible side effects is essential. Understanding these helps you stay safe and talk to your doctor if you notice anything unusual.

Lisinopril 

This medication can cause side effects that range from mild to severe. 

Serious side effects

If you experience any of these, seek emergency medical help right away:

  • Allergic reactions. Severe stomach pain, hives, trouble breathing, or swelling of the face, lips, tongue, or throat.
  • Light-headedness. Feeling like you might faint.
  • High blood potassium (hyperkalemia). Symptoms include nausea, weakness, tingling, chest pain, irregular heartbeats, and loss of movement.
  • Low white blood cell counts (leukopenia). This can cause fever, mouth or skin sores, a sore throat, and a cough.
  • Kidney problems. Signs are swelling, reduced urination, fatigue, and shortness of breath.
  • Liver problems. Look out for loss of appetite, pain in the upper right stomach area, fatigue, itching, dark urine, clay-colored stools, and yellowing of the skin or eyes (jaundice).
  • Severe hyponatremia. Although rare, this condition is linked to Lisinopril use.

Common Side Effects

These side effects are more common and usually don’t need urgent medical care:

  • Headache
  • Dizziness
  • Low blood pressure
  • Cough
  • Chest pain

A clinical study found that 31.7% of patients on Lisinopril had a persistent cough. This cough can be annoying and may cause some people to stop taking the medication. The study also showed that Lisinopril works with other blood pressure medicines like losartan and amlodipine. However, it has more side effects.

Losartan

This medication can cause side effects that range from mild to severe. Here’s a complete overview of what you might experience.

Serious Side Effects

If you notice any of these, seek emergency medical help immediately:

  • Light-headedness. Feeling like you might faint.
  • High blood potassium (hyperkalemia). Symptoms include nausea, weakness, tingling, chest pain, irregular heartbeats, and loss of movement.
  • Kidney problems. Signs are swelling, reduced urination, fatigue, and shortness of breath.

Common Side Effects

These side effects are more common and usually aren’t serious, but they can still impact your daily life:

  • Dizziness
  • Tiredness
  • Low blood pressure
  • Low blood sugar
  • Diarrhea
  • Back pain
  • Cold symptoms like a stuffy nose, sneezing, and sore throat

Allergic Reactions (Emergency Attention Required)

In rare cases, Losartan can cause serious allergic reactions that need urgent medical care. These include:

  • Hives
  • Difficulty breathing
  • Swelling of the face, lips, tongue, or throat

Additionally, Losartan-induced angioedema has been reported, though it is rare. A study was conducted wherein a 60-year-old man developed significant swelling of his face, lips, and tongue after taking Losartan. Despite treatment with antihistamines and steroids, he needed to be intubated to protect his airway. 

Cost and Availability

Here’s a quick guide to the prices and options for Lisinopril and Losartan.

Lisinopril 

Strength (mg)Quantity (pills)Price (USD)
2.5309.52
5.0309.47
10.0159.47
20.01510.0
30.010012.36
40.03010.01

Lisinopril is a medicine you need a prescription for. Its price varies depending on the pharmacy and the strength you need. For example, 15 pills of 20 mg cost about $10. If you need a different strength, the prices change. A pack of 30 pills at 2.5 mg starts at $9.52. For 5 mg, it’s around $9.47 for 30 pills. If you take 10 mg, 15 pills cost $9.47. The 30 mg strength is roughly $12.36 for 100 pills. Need 40 mg? It’s about $10.01 for 30 pills.

You can save money on lisinopril with the free Drugs.com Discount Card. It works like a coupon and can save up to 80% on prescriptions, over-the-counter, and pet medications. Big pharmacies like Walgreens, CVS, Target, Walmart, and Duane Reade accept the Drugs.com Discount Card. Plus, 65,000 other stores across the country take it too. Remember, this card is a discount program, not insurance.

Currently, no patient assistance programs (PAPs) for Lisinopril offer free or cheaper medicine to low-income or uninsured people. However, your healthcare provider might know of local help programs that can assist you.

Losartan

Strength (mg)Quantity (pills)Price (USD)Brand/Generic
253023.0Generic
501511.0Generic
503013.0Generic
1003014.0Generic
5030132.0Brand (Cozaar)

Losartan is also ​​a medicine you need a prescription for. It’s cost depends on the dosage and your pharmacy. A 50 mg tablet costs about $11 for 15 tablets with the Drugs.com Discount Card, which is accepted at most US pharmacies. Prices for 30 tablets vary from $13 for generic losartan to $132 for the brand name Cozaar. Higher or lower dosages, like 100 mg or 25 mg, cost around $14 and $23 for 30 tablets, respectively.

Discounts for losartan include printable coupons, rebates, savings or copay cards, trial offers, and free samples. These may require registration or obtaining a sample from your doctor. 

The free Drugs.com Discount Card can save you up to 80% or more on prescription medicines, over-the-counter drugs, and pet prescriptions. It’s accepted at major chains like Walgreens, CVS, Target, Walmart, and Duane Reade, and 65,000 pharmacies across the country.

Wrap Up

If you have high blood pressure, choosing between Lisinopril vs Losartan for high blood pressure can be tricky. Both medicines help lower your blood pressure but work in different ways. Lisinopril is taken once a day and might cause a cough, while Losartan usually doesn’t have that side effect. 

Both can have other side effects, so talk to your doctor if you feel unwell. Lisinopril is often cheaper, but prices vary, so check with your pharmacy. Losartan also protects your heart and kidneys. Using a discount card can save you money on either medicine. 

Your doctor will help decide which one is best for you based on your health needs. Stay healthy by choosing the right option!

FAQs on Lisinopril vs. Losartan Blood Pressure

Can I switch from lisinopril to losartan?

Yes, switching is possible if you experience side effects like a persistent cough with lisinopril. Your doctor may recommend losartan instead, as it works differently and usually doesn’t cause a cough.

Can I take lisinopril and losartan together?

No, taking both together can increase the risk of serious side effects such as low blood pressure, high potassium levels, and kidney problems. Your doctor will prescribe only one based on your condition.

What should I do if I miss a dose of lisinopril or losartan?

If you miss a dose, take it as soon as you remember. If it’s close to your next dose, skip the missed one and continue with your regular schedule. Don’t take extra doses to make up for a missed one.

Are lisinopril and losartan safe during pregnancy?

No, both medications can harm an unborn baby and should be avoided during pregnancy. If you become pregnant while taking either drug, contact your doctor immediately. 

Sources

  • Gomez, H. J., Smith, S. G., & Moncloa, F. (1988). Efficacy and safety of lisinopril in older patients with essential hypertension. The American Journal of Medicine, 85(3, Suppl. 2), 35-37. https://doi.org/10.1016/0002-9343(88)90348-8
  • Soffer, B., Zhang, Z., Miller, K., Vogt, B. A., & Shahinfar, S. (2003). A double-blind, placebo-controlled, dose–response study of the effectiveness and safety of lisinopril for children with hypertension. American Journal of Hypertension, 16(10), 795–800. https://doi.org/10.1016/S0895-7061(03)00900-2
  • Gradman, A. H., Arcuri, K. E., Goldberg, A. I., Ikeda, L. S., Nelson, E. B., Snavely, D. B., & Sweet, C. S. (1995). A randomized, placebo-controlled, double-blind, parallel study of various doses of losartan potassium compared with enalapril maleate in patients with essential hypertension. Hypertension, 25(6), 1345-1350. https://doi.org/10.1161/01.HYP.25.6.1345
  • Shahinfar, S., Cano, F., Soffer, B. A., Ahmed, T., Santoro, E. P., Zhang, Z., Gleim, G., Miller, K., Vogt, B., & Blumer, J. (2005). A double-blind, dose-response study of losartan in hypertensive children. American Journal of Hypertension, 18(2), 183–190. https://doi.org/10.1016/j.amjhyper.2004.09.009 
  • Tsai, T., Kroehl, M. E., Smith, S. M., Thompson, A. M., Dai, I. Y., & Trinkley, K. E. (2017). Efficacy and safety of twice- vs once-daily dosing of lisinopril for hypertension. Journal of clinical hypertension (Greenwich, Conn.), 19(9), 868–873. https://doi.org/10.1111/jch.13011
  •  Zachariah, P. K., Bonnet, G., Chrysant, S. G., DeBacker, G., Goldstein, R., Herrera, J., Lindner, A., Materson, B. J., Maxwell, M. H., McMahon, F. G., Merrill, R. H., Paton, R. R., Rapp, A. D., Roginsky, M. S., Seedat, Y. K., Sime, F., Vaicaitis, J. S., Weinberg, M. S., & Zusman, R. M. (1987). Evaluation of antihypertensive efficacy of lisinopril compared to metoprolol in moderate to severe hypertension. Journal of Cardiovascular Pharmacology, 9(Suppl. S53-S58). Lippincott-Raven Publishers. Retrieved from https://journals.lww.com/cardiovascularpharm/abstract/1987/00003/evaluation_of_antihypertensive_efficacy_of.13.aspx#
  • Wu, S. C., Liu, C. P., Chiang, H. T., & Lin, S. L. (2004). Prospective and randomized study of the antihypertensive effect and tolerability of three antihypertensive agents, losartan, amlodipine, and lisinopril, in hypertensive patients. Heart and vessels, 19(1), 13–18. https://doi.org/10.1007/s00380-003-0724-x
  • Vedantam, V., Magacha, H. M., Vedantam, N., Dahya, V., & Abu-Heija, U. (2023). A Case Report of Losartan Induced Angioedema. Cureus, 15(3), e36525. https://doi.org/10.7759/cureus.36525
Posted in