From the Guidelines
Lisinopril is indicated for patients with heart failure with reduced ejection fraction (HFrEF) to reduce morbidity and mortality, as well as for patients with hypertension and post-myocardial infarction. The use of ACE inhibitors, such as lisinopril, is beneficial for patients with prior or current symptoms of chronic HFrEF to reduce morbidity and mortality 1.
Indications for Lisinopril
- Heart failure with reduced ejection fraction (HFrEF)
- Hypertension
- Post-myocardial infarction
Dosage and Administration
The initial daily dose of lisinopril is 2.5-5 mg, which can be gradually increased to a maximum of 40 mg daily based on blood pressure response and patient tolerance 1. For patients with kidney impairment or those taking diuretics, a lower starting dose of 2.5-5 mg is recommended.
Mechanism of Action
Lisinopril works by inhibiting angiotensin-converting enzyme (ACE), which prevents the formation of angiotensin II, a powerful vasoconstrictor. This leads to blood vessel relaxation, reduced blood pressure, and decreased cardiac workload.
Side Effects and Precautions
Common side effects of lisinopril include dry cough, dizziness, and headache. Patients should monitor for serious side effects like swelling of the face/lips/tongue, difficulty breathing, or severe dizziness, which require immediate medical attention. Lisinopril should be given with caution to patients with low systemic blood pressure, renal insufficiency, or elevated serum potassium 1.
Clinical Evidence
The clinical strategy of inhibition of the renin-angiotensin system with ACE inhibitors, such as lisinopril, is recommended for patients with chronic HFrEF to reduce morbidity and mortality 1. Randomized controlled trials (RCTs) clearly establish the benefits of ACE inhibition in patients with mild, moderate, or severe symptoms of HF and in patients with or without coronary artery disease 1.
From the FDA Drug Label
INDICATIONS & USAGE 1.1 Hypertension Lisinopril tablets USP are indicated for the treatment of hypertension in adult patients and pediatric patients 6 years of age and older to lower blood pressure. 1.2 Heart Failure Lisinopril tablets USP are indicated to reduce signs and symptoms of systolic heart failure [see Clinical Studies (14.2)]. 1.3 Reduction of Mortality in Acute Myocardial Infarction Lisinopril tablets USP are indicated for the reduction of mortality in treatment of hemodynamically stable patients within 24 hours of acute myocardial infarction.
The indications for Lisinopril are:
- Hypertension: to lower blood pressure in adult patients and pediatric patients 6 years of age and older
- Heart Failure: to reduce signs and symptoms of systolic heart failure
- Reduction of Mortality in Acute Myocardial Infarction: to reduce mortality in hemodynamically stable patients within 24 hours of acute myocardial infarction 2
From the Research
Indications for Lisinopril
Lisinopril, an Angiotensin-Converting Enzyme (ACE) inhibitor, has several indications, including:
- Congestive heart failure: Lisinopril has been shown to reduce the risk of major clinical events, such as death or hospitalization, in patients with heart failure 3, 4.
- Hypertension: Lisinopril is effective in lowering blood pressure in elderly patients with hypertension 4.
- Acute myocardial infarction: Lisinopril has been shown to reduce mortality and cardiovascular morbidity when administered early in the treatment of myocardial infarction 5.
- Diabetic nephropathy: Lisinopril may improve or slow the deterioration of renal function in patients with diabetic nephropathy 4.
Key Benefits
The use of Lisinopril has several key benefits, including:
- Reduced risk of mortality and morbidity in patients with heart failure and acute myocardial infarction 3, 5.
- Improved symptomatic benefits in patients with congestive heart failure 3.
- Effective in lowering blood pressure in elderly patients with hypertension 4.
- May improve or slow the deterioration of renal function in patients with diabetic nephropathy 4.
Comparison with Other ACE Inhibitors
Lisinopril has been compared with other ACE inhibitors, such as captopril, enalapril, and ramipril, and has been shown to be at least as effective and well-tolerated 3, 4, 6.