From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
For managing periodic blood pressure spikes, lisinopril is generally preferred over propranolol as a first-line treatment, due to its ability to provide consistent 24-hour blood pressure control and directly address the renin-angiotensin system that regulates blood pressure. Lisinopril, an ACE inhibitor, is typically started at a dose of 10mg daily, adjustable up to 40mg, and offers additional benefits including kidney protection and reduced risk of diabetes, while causing fewer side effects like fatigue and sexual dysfunction compared to propranolol 1. However, lisinopril may cause a dry cough in some patients and should be avoided in pregnancy.
Key Considerations
- Propranolol, a beta-blocker, requires multiple daily doses and primarily works by reducing heart rate and cardiac output, making it less effective for isolated blood pressure spikes.
- The most recent and highest quality study suggests that ACE inhibitors like lisinopril may not be the best choice for hypertension treatment due to their association with cough and angioedema, and the equal efficacy of angiotensin receptor blockers (ARBs) with fewer adverse events 1.
- Home blood pressure monitoring is recommended to track patterns of spikes, and lifestyle modifications including reduced sodium intake, regular exercise, stress management, and limiting alcohol and caffeine should complement medication therapy.
- If blood pressure remains uncontrolled with a single medication, combination therapy may be necessary, and the choice of medication should be based on the individual patient's needs and medical history.
Dosage and Administration
- Lisinopril is typically started at a dose of 10mg daily, adjustable up to 40mg, and can be administered once or twice daily, with twice-daily administration associated with greater systolic blood pressure reductions 2.
- Propranolol is typically started at a dose of 40mg twice daily, up to 320mg total daily, and requires multiple daily doses.
Special Considerations
- Lisinopril should be avoided in pregnancy due to the potential risk of fetal harm.
- Patients with a history of angioedema or cough should be monitored closely when taking lisinopril.
- The choice of medication should be based on the individual patient's needs and medical history, and the potential benefits and risks of each medication should be carefully considered 3, 4.