Is losartan (an angiotensin II receptor antagonist) more effective than lisinopril (an angiotensin-converting enzyme inhibitor)?

From the Guidelines

Losartan is not definitively better than lisinopril, but it may be preferred for patients who experience ACE inhibitor-related cough or angioedema, while lisinopril might be favored for patients with heart failure or following a heart attack. When considering the treatment of high blood pressure and certain heart conditions, both losartan and lisinopril are effective options, but they may be more suitable for different patients based on individual factors.

Key Considerations

• Losartan is an angiotensin II receptor blocker (ARB) while lisinopril is an angiotensin-converting enzyme (ACE) inhibitor.
• Losartan may be preferred for patients who experience ACE inhibitor-related cough (which affects about 10-20% of patients on lisinopril) or angioedema, as seen in the study by 1.
• Lisinopril might be favored for patients with heart failure or following a heart attack, as it has more extensive research supporting these uses, such as the Assessment of Treatment with Lisinopril And Survival (ATLAS) trial 1.

Dosage and Mechanism

• Both medications are typically taken once daily, with losartan usually dosed at 25-100mg and lisinopril at 5-40mg.
• They work similarly by affecting the renin-angiotensin-aldosterone system to relax blood vessels, but through different mechanisms.
• The choice between these medications should be made with your healthcare provider based on your specific medical conditions, potential side effects, cost considerations, and other medications you may be taking, as suggested by 1 and 1.

Side Effects and Quality of Life

• Side effect profiles differ slightly, with lisinopril more commonly causing cough and potentially more severe angioedema, while losartan may have fewer of these specific side effects.
• The CHARM trials and Val-HeFT also showed that ARBs, such as losartan, improve symptoms and quality of life, as reported by 1.

From the Research

Comparison of Losartan and Lisinopril

• There are no direct comparisons between losartan and lisinopril in the provided studies.
• However, the studies suggest that losartan is effective in reducing blood pressure and left ventricular hypertrophy, and has been shown to be more effective than atenolol in reducing the risk of stroke and cardiovascular mortality in patients with hypertension and left ventricular hypertrophy 2, 3, 4.
• Losartan has also been compared to other antihypertensive agents, such as captopril, enalapril, and valsartan, and has been shown to be as effective or more effective in reducing blood pressure and left ventricular hypertrophy 5, 6.
• The studies suggest that losartan is well tolerated and has a low risk of adverse events, making it a potential option for first-line therapy in patients with hypertension 5, 4.

Efficacy of Losartan

• Losartan has been shown to be effective in reducing blood pressure and left ventricular hypertrophy in patients with hypertension 2, 5, 6.
• The Losartan Intervention For Endpoint reduction in hypertension (LIFE) study demonstrated that losartan was more effective than atenolol in reducing the risk of stroke and cardiovascular mortality in patients with hypertension and left ventricular hypertrophy 2, 3, 4.
• Losartan has also been shown to be effective in reducing the risk of new-onset diabetes mellitus compared to atenolol 2.

Limitations

• There are no direct comparisons between losartan and lisinopril in the provided studies.
• The studies have some limitations, including the lack of long-term mortality and morbidity data for losartan 5.
• Additionally, the studies suggest that the benefits of losartan may not apply to all patient populations, such as black patients 2, 4.