From the Guidelines
Lisinopril 20mg is recommended over losartan 100mg for patients with heart failure with reduced ejection fraction (HFrEF) due to its established benefits in reducing morbidity and mortality, as evidenced by the 2017 ACC/AHA/HFSA guideline update 1.
Comparison of Lisinopril and Losartan
Lisinopril, an ACE inhibitor, and losartan, an angiotensin II receptor blocker (ARB), are both used to treat high blood pressure and heart failure. However, they have different mechanisms of action and side effect profiles.
- Lisinopril has a higher risk of causing a dry cough (about 10-20% of patients) due to its inhibition of kininase and increase in bradykinin levels 1.
- Losartan, on the other hand, typically causes fewer cough issues and may be better tolerated by some patients, particularly those who experienced cough with ACE inhibitors.
Dosage and Administration
Both medications are typically taken once daily.
- Lisinopril should be taken on an empty stomach, while losartan can be taken with or without food.
- The target dose for lisinopril is 20 mg once daily, while the target dose for losartan is 100 mg once daily, although the ACC/AHA guidelines recommend a target dose of 150 mg 1.
Clinical Considerations
The choice between lisinopril and losartan should be based on individual factors, including cost considerations, other medical conditions, and previous medication experiences.
- Blood pressure monitoring is necessary after starting either medication to ensure proper dosing and effectiveness.
- Neither medication should be used during pregnancy, and caution should be exercised in patients with low systemic blood pressure, renal insufficiency, or elevated serum potassium.
Guideline Recommendations
The 2017 ACC/AHA/HFSA guideline update recommends the use of ACE inhibitors, such as lisinopril, as a first-line treatment for patients with HFrEF, due to their established benefits in reducing morbidity and mortality 1.
- The guideline also recommends the use of ARBs, such as losartan, as an alternative for patients who are intolerant of ACE inhibitors.
- The 2020 ACC/AHA clinical performance and quality measures for adults with heart failure provide target doses for ACE inhibitors and ARBs, including lisinopril and losartan 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Comparison of Lisinopril and Losartan
- Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor, whereas losartan is an angiotensin II receptor antagonist.
- A study from 1997 2 suggests that ACE inhibitors, such as lisinopril, may be preferred as initial therapy in certain subsets of hypertensive patients.
- Another study from 2005 3 found that losartan had similar effects to captopril, an ACE inhibitor, in terms of mortality and risk of clinical deterioration in patients with heart failure.
Efficacy of Lisinopril
- Lisinopril has been shown to be effective in lowering blood pressure in patients with essential hypertension, with dosages of 20 to 80 mg once daily being effective 4.
- A review of lisinopril's pharmacology and clinical efficacy in elderly patients found that it was effective in lowering blood pressure and improving symptoms in patients with congestive heart failure 5.
- The Assessment of Treatment with Lisinopril and Survival (ATLAS) study found that high doses of lisinopril (32.5 to 35mg, administered once daily) demonstrated clinically important advantages over low doses (2.5 to 5mg, administered once daily) in the treatment of congestive heart failure 6.
Efficacy of Losartan
- Losartan has been shown to have haemodynamic effects similar to ACE inhibitors, but with certain differences in mechanism of action and adverse effects 3.
- A study from 2005 3 found that losartan had similar effects to captopril, an ACE inhibitor, in terms of mortality and risk of clinical deterioration in patients with heart failure.
- However, the same study found that losartan may be less effective than captopril in certain patients, and that the addition of losartan to ongoing captopril therapy did not reduce mortality or morbidity, but did increase the risk of adverse effects 3.
Comparison of Lisinopril 20mg and Losartan 100mg
- There is limited direct comparison between lisinopril 20mg and losartan 100mg in the provided studies.
- However, based on the available evidence, it appears that both medications can be effective in treating hypertension and heart failure, but may have different efficacy and safety profiles in certain patient populations 4, 2, 3, 5, 6.