Losartan vs lisinopril effectiveness
Pro Research Analysisby 
Searched over 200M research papers
Comparative Effectiveness of Losartan vs Lisinopril for Blood Pressure Control
Multiple studies have compared the effectiveness of losartan (an angiotensin receptor blocker, ARB) and lisinopril (an angiotensin-converting enzyme inhibitor, ACEI) in lowering blood pressure. Both drugs significantly reduce systolic and diastolic blood pressure in patients with hypertension, with some studies showing similar rates of achieving target blood pressure for both medications 238. However, one study found that lisinopril was more effective than losartan in reducing blood pressure and pulse pressure, especially when measured at home or with ambulatory monitoring, rather than in the clinic . Another study found that losartan was more effective than lisinopril in 24-hour blood pressure monitoring, but both drugs achieved target blood pressure in a similar proportion of patients .
Cardiovascular and Renal Outcomes: Heart and Kidney Protection
In patients with cardiomyopathy due to Duchenne muscular dystrophy, both lisinopril and losartan led to significant and similar improvements in heart function (measured by ejection fraction) over one year, with no difference in effectiveness between the two drugs . For patients with proteinuric kidney disease, lisinopril and losartan both reduced proteinuria, but higher doses of lisinopril were more effective than losartan. Combination therapy with both drugs reduced proteinuria even further, but the safety of this approach needs more study . In children with mild IgA nephropathy, lisinopril alone was as effective as combination therapy with losartan in reducing proteinuria, suggesting no added benefit from combining the two drugs in this setting .
Additional Health Effects: Cognitive Function and Insulin Sensitivity
Some studies have looked at effects beyond blood pressure. Losartan improved cognitive function more than lisinopril in older adults with hypertension, independent of its blood pressure-lowering effect . On the other hand, lisinopril improved insulin sensitivity in non-diabetic hypertensive patients, while losartan did not have a significant effect on insulin sensitivity .
Myocardial Perfusion and Heart Health
Lisinopril improved myocardial perfusion reserve and maximal coronary blood flow in patients with hypertension and left ventricular hypertrophy, while losartan did not show these benefits. This suggests that lisinopril may be more effective in repairing coronary microvascular problems related to hypertension .
Tolerability and Side Effects: Cough and Other Adverse Events
A key difference between the two drugs is the risk of cough. Lisinopril is associated with a much higher incidence of dry cough compared to losartan, especially in patients with a history of ACE inhibitor-induced cough 8910. Losartan’s incidence of cough is similar to placebo, making it a better option for patients who experience cough with ACE inhibitors. Other side effects, such as leg edema, were more common with amlodipine (a different drug), while lisinopril had a higher rate of cough and losartan had fewer overall adverse effects . Animal studies also confirm that lisinopril increases cough reflex sensitivity more than losartan .
Conclusion
Both losartan and lisinopril are effective for lowering blood pressure and protecting the heart and kidneys. Lisinopril may have advantages in improving insulin sensitivity and myocardial perfusion, while losartan may be better for cognitive function and is much less likely to cause cough. The choice between the two often depends on individual patient needs, side effect profiles, and specific health conditions.
Sources and full results
Most relevant research papers on this topic