Lisinopril vs. Benazepril and More: What’s the Best ACE Inhibitor?
Key takeaways:
Angiotensin-converting enzyme (ACE) inhibitors are a commonly prescribed class of medications for high blood pressure and other heart-related conditions.
Lisinopril (Zestril, Qbrelis), enalapril (Vasotec), and benazepril (Lotensin) are popular ACE inhibitors. The best ACE inhibitor for you depends on why you’re taking it, your medical history, and other factors.
Many ACE inhibitors are available as lower-cost generics. You may be able to get a month’s supply of lisinopril, enalapril, and benazepril for less than $10 at certain pharmacies with a GoodRx coupon.
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Table of contents
If you have hypertension (high blood pressure), your healthcare professional may recommend an angiotensin-converting enzyme (ACE) inhibitor. These medications are first-choice options to treat high blood pressure.
There are many different ACE inhibitors available. Lisinopril (Zestril, Qbrelis), enalapril (Vasotec, Epaned), quinapril (Accupril), and benazepril (Lotensin) are popular options. While these ACE inhibitors have a lot in common, they also have some notable differences. Here, we’ll compare these medications and get to the heart of a frequently asked question: What’s the best ACE inhibitor?
What are ACE inhibitors?
ACE inhibitors are a class of medications that have been around for decades. They’re pretty easy to identify because their names end in “-pril.”
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ACE inhibitors have several functions, such as decreasing blood pressure, improving heart function, and protecting the kidneys. This is why they treat multiple health conditions, including:
ACE inhibitors work by decreasing levels of a hormone called angiotensin II. This relaxes the blood vessels and lowers blood pressure. ACE inhibitors also help the kidneys remove more water and sodium from the body.
Most ACE inhibitors are available as oral pills, but some are also available as an oral solution or an injection. Some ACE inhibitors also come as part of a combination pill that contains an additional medication. For example, quinapril is combined with a diuretic called hydrochlorothiazide in Accuretic, which comes as a tablet. And lisinopril is combined with the same diuretic in a combination tablet called Zestoretic.
What are the names of common ACE inhibitors?
A list of common ACE inhibitors is below:
Lisinopril
Enalapril
Benazepril
Quinapril
Side effects of angiotensin-converting enzyme (ACE) inhibitors: Like all medications, ACE inhibitors have possible side effects to know about. But most people tolerate ACE inhibitors well.
Angiotensin II receptor blockers (ARBs) vs. ACE inhibitors: These two common blood pressure medications have several similarities. But they also have a few notable differences.
ACE inhibitor facts: Learn key information about ACE inhibitors, including what their potential side effects are, how to take them, and more.
The three most commonly prescribed ACE inhibitors are lisinopril, enalapril, and benazepril. In fact, in 2022, lisinopril was the third most commonly prescribed medication in the U.S.
What is the best ACE inhibitor?
There’s no single best ACE inhibitor. They are all approved to treat high blood pressure, and they all work similarly well for this condition. But there are slight differences between the medications that may make one ACE inhibitor a better choice for you than others.
Differences between individual ACE inhibitors
When considering which ACE inhibitor is best for you, here are some differences to think about:
Dosages: Most ACE inhibitors, including lisinopril and enalapril, are taken once a day, but some are taken more frequently. Captopril, for example, doesn’t stay in the body very long so it needs to be taken 3 times a day in most cases. And quinapril is most often taken 2 times a day.
With or without food: Captopril should be taken on an empty stomach, at least 1 hour before meals or 2 hours after a meal. Other ACE inhibitors, such as lisinopril, benazepril, and enalapril, can be taken with or without food. However, with all ACE inhibitors, it’s best to take doses at the same time each day. This helps maintain consistent medication levels in your blood.
How they’re broken down in the body: Most ACE inhibitors are broken down (metabolized) in the liver. That can be an issue if you have liver disease or another condition that causes your liver to work not as well as it could. Lisinopril and captopril aren’t metabolized in the liver. So they may be better options for people with liver problems.
Oral forms: Lisinopril and enalapril come as an oral liquid, and benazepril can be made into a liquid by a pharmacist. Ramipril (Altace) capsules can be opened and sprinkled on applesauce. These forms can be helpful for people who can’t swallow pills and for children.
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For more context, here’s a brief comparison of the three most commonly prescribed ACE inhibitors.
Common brand names | Zestril and Qbrelis | Vasotec and Epaned | Lotensin |
Forms and doses | • Tablets: 2.5 mg, 5 mg, 10 mg, 20 mg, 30 mg, 40 mg | • Tablets: 2.5 mg, 5 mg, 10 mg, 20 mg | • Tablets: 5 mg, 10 mg, 20 mg, 40 mg |
How many times a day they are taken | Once daily | 1-2 times a day | 1-2 times a day |
Approved uses | • High blood pressure | • High blood pressure | • High blood pressure |
Cost with a GoodRx coupon |
Do ACE inhibitors have drug interactions?
Lisinopril, benazepril, and other ACE inhibitors have similar potential drug interactions. Some medications and supplements that can interact with ACE inhibitors are:
Nonsteroidal anti-inflammatory drugs (NSAIDS): Combining ACE inhibitors with NSAIDS such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn) can increase the risk of kidney problems.
Potassium supplements, such as potassium chloride: ACE inhibitors can raise your potassium levels. So taking these supplements with an ACE inhibitor can cause your potassium levels to get too high.
Lithium: Combining ACE inhibitors with lithium (Lithobid) can cause lithium to build up in your body. This can result in lithium toxicity, which can become life-threatening.
Entresto: Avoid ACE inhibitors if you’re taking Entresto (sacubitril / valsartan). This combination can raise the risk of angioedema (swelling of the face, tongue, and throat).
Aliskiren: You shouldn’t take ACE inhibitors and aliskiren (Tekturna) together. These medications work similarly, so this combination increases the risk of side effects.
Keep in mind that this isn’t an exhaustive list. Be sure to give your prescriber and pharmacist a list of medications and supplements you’re taking before starting treatment with an ACE inhibitor.
What are the potential side effects of ACE inhibitors?
ACE inhibitors share similar side effects, including:
Low blood pressure
Persistent dry cough
Headaches
Dizziness
You can develop a cough at any time while you’re taking an ACE inhibitor. If you have a cough that becomes bothersome, there are other medication options available, like angiotensin II receptor blockers (ARBs). ARBs work in a similar manner as ACE inhibitors, but with a lower likelihood of causing a cough.
Although less common, ACE inhibitors can also cause more serious side effects, such as:
Angioedema: Angioedema is a rare, but potentially life-threatening side effect of ACE inhibitors. Call 911 or go to the nearest emergency room if you have swelling in your lips, tongue, or throat and difficulty breathing. Black people are at higher risk for this side effect.
Hyperkalemia: Hyperkalemia (high potassium levels) doesn’t always cause symptoms, but it’s possible to experience weakness, fatigue, or tingling sensations. Let your prescriber know if you experience these symptoms. They may recommend checking your potassium levels.
Kidney problems: If you have kidney problems, taking an ACE inhibitor can make things worse. So your prescriber may recommend taking a lower dosage than usual. And they’ll likely want to monitor your kidney function by ordering certain blood tests during treatment.
Who shouldn’t take ACE inhibitors?
ACE inhibitors are safe and effective for most people. However, they should be avoided in some instances, including:
If you’re pregnant or planning to become pregnant
If you have a history of angioedema from an ACE inhibitor
If you have hereditary angioedema or idiopathic angioedema (angioedema without a known cause)
If you take aliskiren and have diabetes
If you take Entresto
If you have hyperkalemia or decreased kidney function, your prescriber may want to monitor you more carefully during treatment. Or they may recommend another medication altogether.
Lastly, while ACE inhibitors are first-choice blood pressure medications for many people, this isn’t true for everyone. For example, ACE inhibitors aren’t usually first-choice treatments for hypertension in Black adults, because they haven’t been found to be as effective as other groups of blood pressure medications, such as thiazide diuretics and calcium channel blockers.
How to save on ACE inhibitors
As mentioned, most ACE inhibitors are available as lower-cost generics. But there may be other ways to save on your medication, including using a GoodRx coupon. At some pharmacies, you may be able to pay as little as $5 for your ACE inhibitor prescription with a free coupon.
GoodRx can also help you navigate copay savings cards and patient assistance programs like those for:
Zestril: If you have commercial insurance, you may be eligible to pay as little as $28 per month for Zestril using a savings card from the manufacturer.
Qbrelis: If you have commercial insurance, you may be eligible to pay as little as $30 per Qbrelis prescription with a savings card from the manufacturer. If you’re uninsured or underinsured, you may qualify for Qbrelis’ patient assistance program, which offers the medication free of cost.
The bottom line
Angiotensin-converting enzyme (ACE) inhibitors are some of the most commonly prescribed medications in the U.S. These medications are used to treat high blood pressure and other heart-related issues. Most ACE inhibitors are generally well tolerated and come as lower-cost generics.
There are many ACE inhibitors to choose from, including lisinopril (Zestril, Qbrelis), quinapril (Acupril), and benazepril (Lotensin). The best ACE inhibitor for you depends on why you’re taking it, your medical history, and other factors.
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References
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