Lisinopril vs. Losartan for High Blood Pressure: 8 Similarities and Differences You Should Know

If you have high blood pressure, taking medications like lisinopril (Zestril, Qbrelis) or losartan (Cozaar) can help lower your risk of serious health problems. That’s because if it’s left untreated, high blood pressure can lead to a heart attack, kidney problems, or a stroke.

While lisinopril and losartan work in a similar way, there are a few reasons why you might take one over the other — or a different medication altogether. Below are eight similarities and differences between lisinopril and losartan you should know about.

What is lisinopril?

Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor. It’s available as a tablet (Zestril) and an oral solution (Qbrelis). If you’re prescribed lisinopril, you’ll typically take it once a day. 

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Lisinopril is approved to treat:

• High blood pressure in people 6 years of age and older

• Heart failure

• Heart attack

Experts also recommend medications like lisinopril for certain people with chronic kidney disease (CKD) or diabetes to slow down the worsening of kidney problems.

What is losartan?

Losartan is an angiotensin II receptor blocker (ARB). It’s only available as a tablet that’s taken once a day. Losartan is approved for:

• Treating high blood pressure in people 6 years of age and older

• Lowering the risk of stroke in people with high blood pressure and left ventricular hypertrophy (thickened lower left chamber of the heart)

• Treating kidney damage in certain people with high blood pressure and Type 2 diabetes (also known as diabetic nephropathy)

Losartan is also sometimes prescribed off-label for heart failure and CKD, as well as diabetic nephropathy in people with normal blood pressure. It has potential benefits for people with an inherited condition called Marfan syndrome. 

8 similarities and differences between lisinopril and losartan

Lisinopril and losartan are two first-choice medications for treating high blood pressure. They have several similarities, but there are also a few key differences to consider.

1. Lisinopril and losartan work on the same system, but in different ways

There’s a system in your body that helps maintain your blood pressure. One hormone involved in this system is angiotensin II. It tightens your blood vessels and makes your body hold on to more fluid, causing your blood pressure to rise. 

Both lisinopril and losartan interfere with this system, but in different ways. Lisinopril decreases how much angiotensin II is made. Losartan blocks angiotensin II from attaching to its receptors (binding sites) in your blood vessels, kidneys, and other organs. 

In short, both medications prevent angiotensin II from doing its job. This causes your blood vessels to relax, which can lower your blood pressure.

2. Lisinopril and losartan are both first-choice treatments for high blood pressure, but you may be more likely to start with lisinopril

Both lisinopril and losartan work well to treat high blood pressure. But there are some reasons why your healthcare provider might recommend lisinopril first. 

If you have CKD, ACE inhibitors like lisinopril are typically recommended over ARBs like losartan. That’s because there’s more data supporting their benefits for the kidneys. ACE inhibitors have also been shown to lower the risk of death from all causes in people with CKD, including death related to heart disease.

But what happens if you aren’t able to tolerate lisinopril? In this case, your healthcare provider might switch you to an ARB like losartan. More on that later.

3. Lisinopril and losartan may not be first-choice treatments in Black adults

Medications like lisinopril and losartan generally aren’t recommended for treating high blood pressure in Black adults. Studies suggest they don’t work as well as other options in this population. And angioedema, a serious side effect involving swelling of the face, neck, and mouth, may be more likely in this group if they take these medications.

If you’re a Black adult without heart failure or CKD, your healthcare provider will likely recommend a different medication. First-choice options typically include a thiazide diuretic or calcium channel blocker.

4. Lisinopril and losartan have potential benefits and risks for your kidneys

Experts recommend medications like lisinopril or losartan for certain people due to their positive effects on the kidneys. As mentioned above, this can include people with diabetes and/or CKD. 

If you don’t have these other health conditions, you can help prevent future kidney problems by keeping your blood pressure under control with these medications. This involves taking them as prescribed and sticking with heart-healthy lifestyle changes long term.

However, lisinopril and losartan can also affect how well your kidneys work. They block processes in your body that make up for low blood flow to your kidneys. And in certain situations, this can result in your kidneys filtering your blood less efficiently. Fortunately, this is usually reversible.

Certain risk factors, including heart failure, CKD, and dehydration can increase the risk of kidney problems with lisinopril or losartan. Kidney problems are also more likely if you’re taking them with other medications that harm your kidneys, like ibuprofen.

Despite this risk, people with kidney disease can still benefit from taking lisinopril or losartan. In this case, your healthcare provider may want to monitor your kidney function more closely.

5. Lisinopril is more likely to cause a dry cough than losartan

ACE inhibitors like lisinopril can cause a dry cough as a side effect. And once it develops, the cough doesn’t usually go away until you stop taking lisinopril. However, dry cough tends to be less likely with ARBs like losartan. 

Lisinopril blocks an enzyme called ACE. Normally, ACE breaks down other substances that can cause coughing. But when ACE is blocked, these substances can build up in your body. Experts don’t know for sure, but this is thought to result in a dry cough.

Losartan doesn’t block ACE. So, cough isn’t as common of a side effect. If you develop a bothersome dry cough with lisinopril, switching to losartan may be an option to consider.

6. Lisinopril and losartan have similar interactions

Because of how they work, lisinopril and losartan can interact with several of the same medications. Common examples include:

• Non-steroidal anti-inflammatory drugs (NSAIDs), like ibuprofen and naproxen

• Medications that increase potassium levels, like spironolactone (Aldactone)

• Lithium (Lithobid)

• Aliskiren (Tekturna)

• Entresto (sacubitril/valsartan)

Before starting lisinopril or losartan, make sure your healthcare provider has your current medication list. They can check for potential interactions and manage them in advance.

7. Lisinopril and losartan aren’t safe during pregnancy

Lisinopril and losartan should be avoided during pregnancy. This is because they can cause harm to the fetus. In fact, all ACE inhibitors and ARBs have a boxed warning (the FDA’s strictest warning) about avoiding them if you’re pregnant.

If you become pregnant while taking either of these medications, let your healthcare provider know right away. They’ll help you find a safer alternative.

8. Lisinopril and losartan are both available in combination products

Some people taking lisinopril or losartan may need to take an additional medication to help them meet their blood pressure goals. Diuretics (water pills) like hydrochlorothiazide are a common choice. 

If you’re interested in simplifying your routine, a combination pill can be a convenient option.

Lisinopril can be combined with hydrochlorothiazide as Zestoretic, a once-daily pill. Losartan is also available with hydrochlorothiazide as Hyzaar. Instead of taking the two medications separately, you only need to take one pill each day.

Can you switch from lisinopril to losartan?

Yes. It’s possible to switch from lisinopril to losartan. Your healthcare provider may recommend making the switch if you develop a bothersome cough with lisinopril. But they’ll need to write you a new prescription.

Keep in mind: Don’t stop taking lisinopril until you have your new prescription. Your healthcare provider will help you switch medications safely.

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Written by:

Kristianne Hannemann, PharmD

Kristianne Hannemann, PharmD, is a licensed pharmacist in California. She has been a retail pharmacy manager and staff pharmacist for over 7 years and has contributed drug information content to different health companies.

Edited by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

Reviewed by:

Sarah A. Samaan, MD

Sarah Samaan, MD, FACC, FACP, FASE is a board-certified cardiologist who practiced clinical cardiology for nearly 30 years. She is a member of the American College of Cardiology, the American College of Physicians, and the American Society of Echocardiography.

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