Does Lisinopril Drop Heart Rate?
Lisinopril does not significantly affect heart rate in most patients, as it works primarily through inhibition of the angiotensin-converting enzyme system rather than through direct chronotropic effects. 1, 2
Mechanism of Action and Cardiovascular Effects
Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor that:
- Inhibits ACE activity, reducing plasma angiotensin II and aldosterone
- Increases plasma renin activity
- Produces gradual blood pressure reduction
- Does not typically affect heart rate or cardiovascular reflexes 2
Unlike beta-blockers, which have negative chronotropic (heart rate lowering) and inotropic (contractility reducing) effects, ACE inhibitors like lisinopril work through different mechanisms:
- Beta-blockers directly decrease heart rate and are often used when heart rate control is needed 3
- ACE inhibitors primarily affect the renin-angiotensin-aldosterone system
Evidence from Clinical Studies
The FDA drug label for lisinopril specifically states that it produces blood pressure reduction "with little or no change in cardiac output and in heart rate" 1. This is supported by clinical pharmacology studies showing that lisinopril produces smooth, gradual blood pressure reduction without affecting heart rate 2.
In a study examining lisinopril's effects in patients with heart failure and atrial fibrillation, heart rate during exercise and ambulatory monitoring was not significantly affected 4. Similarly, another study found that lisinopril successfully reduced mean blood pressure "without modification in heart rate" 5.
Electrophysiological Effects
Research on isolated guinea pig hearts showed that lisinopril did not affect heart rate at any of the concentrations tested 6. This further supports the finding that lisinopril lacks direct chronotropic effects.
Potential Exceptions
There are some specific situations where indirect effects on heart rate might be observed:
- In patients with heart failure, improved cardiac function from ACE inhibitor therapy might indirectly affect heart rate patterns
- When used in combination with other medications that do affect heart rate (like beta-blockers)
Clinical Implications
When heart rate reduction is a clinical goal (such as in angina or certain arrhythmias):
- Beta-blockers are typically the preferred agents due to their negative chronotropic effects 3
- Ivabradine, which selectively inhibits the If current in the sinus node, is specifically designed to reduce heart rate 3
- ACE inhibitors like lisinopril would not be selected primarily for heart rate control
Summary
Lisinopril is effective for blood pressure reduction and has beneficial effects in heart failure and post-myocardial infarction patients, but it does not significantly affect heart rate. When heart rate reduction is desired, other medications like beta-blockers or ivabradine would be more appropriate choices.