Lisinopril vs Losartan: Which Blood Pressure Medication Is Better?

Lisinopril and losartan remain two of the most commonly prescribed blood pressure medications in the United States. Both act on the renin-angiotensin-aldosterone system (RAAS) but in different ways, which gives them distinct side effect profiles and clinical uses. A careful lisinopril vs losartan comparison can help you understand those differences and have a more productive conversation with the clinician who actually prescribes and monitors your treatment. This article explains how the two drugs compare; it is educational and is not a substitute for medical advice, and it deliberately does not include dosing, because dosing is an individualized decision your prescriber makes. For related reading, see our medical conditions guide.

Overview: Lisinopril and Losartan

Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor. It works by blocking the enzyme that converts angiotensin I into angiotensin II, a powerful hormone that narrows blood vessels. By lowering angiotensin II levels, lisinopril allows blood vessels to relax and widen, which reduces blood pressure. It was approved by the FDA in the late 1980s and has long been available as a low-cost generic, formerly under the brand names Prinivil and Zestril.

Losartan is an angiotensin II receptor blocker (ARB). Rather than preventing the formation of angiotensin II, losartan blocks the receptors where angiotensin II would otherwise bind. The end result is similar: blood vessels relax, blood pressure falls, and the heart’s workload is reduced. Losartan was the first ARB brought to market, approved in the mid-1990s, originally under the brand name Cozaar. Both drugs are now widely available as inexpensive generics.

Because the two drugs interrupt the same hormonal pathway at different points, they share many benefits and several risks. Their differences in tolerability, especially cough and angioedema, are often what tip the decision one way or the other.

Lisinopril vs Losartan: Comparison Table

The table below summarizes how the two compare on the features that matter most in everyday practice. Note that it intentionally does not list doses; the right dose depends on your kidney function, blood pressure, other conditions, and other medications, and only your prescriber should set or adjust it.

Effectiveness for Blood Pressure

Both lisinopril and losartan are effective at lowering blood pressure, and clinical trials have shown broadly comparable reductions in systolic and diastolic pressure at standard doses. The American Heart Association and the American College of Cardiology include both ACE inhibitors and ARBs among the recommended first-line classes of antihypertensive medication, alongside thiazide-type diuretics and calcium channel blockers.

Head-to-head studies comparing the two for blood pressure control have generally found similar efficacy. Some analyses suggest ACE inhibitors have a slightly larger body of long-term cardiovascular outcome data, while ARBs like losartan tend to be better tolerated because they rarely cause cough. In practice, the difference in blood pressure lowering between the two is usually small; tolerability and your specific medical picture matter more.

Both medications also offer benefits beyond blood pressure. Lisinopril is commonly used to protect heart function after a heart attack and in heart failure. Losartan has strong evidence for slowing kidney disease in people with type 2 diabetes and for reducing stroke risk in selected patients with high blood pressure and left ventricular hypertrophy. Losartan also has a mild uric-acid-lowering effect that is sometimes considered a modest bonus in people who also have gout, though it is not a gout treatment.

Side Effects Compared

The most talked-about difference in the lisinopril vs losartan comparison is cough. ACE inhibitors like lisinopril can cause a persistent, dry, tickling cough in a meaningful minority of patients. It is thought to result from the buildup of bradykinin, a substance that ACE normally helps break down. This cough is the single most common reason people switch from an ACE inhibitor to an ARB.

Losartan does not affect bradykinin in the same way and therefore rarely causes cough. If you develop a nagging dry cough on lisinopril, switching to an ARB such as losartan often resolves it within a few weeks. This is the classic clinical scenario in which someone moves from lisinopril to losartan, and it should be done under a prescriber’s guidance rather than by stopping on your own.

Angioedema is a rare but serious side effect involving rapid swelling of the face, lips, tongue, or throat, and it occurs more often with ACE inhibitors than with ARBs. According to the Mayo Clinic and other authorities, angioedema is uncommon but is more frequently reported in Black patients and can develop even after months or years of taking the drug without problems. Although angioedema can rarely occur with ARBs too, the risk is substantially lower, which is one reason a prescriber may switch someone to losartan after an ACE-inhibitor reaction. Because swelling of the tongue or throat can block the airway, angioedema is a medical emergency (see the box below).

Both medications can cause dizziness or lightheadedness, especially when first starting or after a dose change, because they lower blood pressure. Both can raise blood potassium (hyperkalemia) and can reduce kidney function in susceptible people, which is why prescribers typically check bloodwork after starting or adjusting either drug. Neither should be used in pregnancy.

Potassium, Kidneys, and Drug Interactions

Lisinopril and losartan share several interactions because they both act on the RAAS. The most important safety point for many people is potassium. Both drugs can raise potassium, so combining them with potassium supplements, potassium-based salt substitutes (often marketed as “lite” or “no-salt” seasonings that use potassium chloride), or potassium-sparing diuretics can push potassium too high unless a clinician is specifically monitoring it. High potassium can affect the heart’s rhythm and is usually silent until it is serious, which is why bloodwork matters.

Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen can blunt the effect of both medications and, especially in combination, can strain the kidneys and raise potassium. Talk to your pharmacist before using over-the-counter pain relievers regularly. As a general rule, an ACE inhibitor and an ARB should not be combined with each other, and neither should be combined with the direct renin inhibitor aliskiren in people with diabetes or significant kidney disease, because doing so increases the risk of low blood pressure, high potassium, and kidney injury. If you are prescribed a heart failure medication such as sacubitril/valsartan, it should not be taken together with an ACE inhibitor, and a washout period is required when switching from lisinopril, again because of angioedema risk. Your prescriber and pharmacist manage these transitions.

You may also recall news of manufacturer recalls of certain ARB lots (including some losartan) several years ago over trace nitrosamine impurities. Those specific recalls were addressed by regulators and manufacturers; if you ever have a question about a particular lot, your pharmacy can confirm current supply. It is not a reason to stop taking a prescribed medication on your own.

Pregnancy: A Critical Safety Point

Both ACE inhibitors and ARBs carry an FDA boxed warning against use during pregnancy. When used in the second and third trimesters, drugs that act on the RAAS can cause serious injury and even death to a developing baby, and they should be stopped as soon as pregnancy is detected. If you are pregnant, think you might be pregnant, are trying to conceive, or are of childbearing age and not using reliable contraception, tell your prescriber so they can choose a blood pressure medication with a safer pregnancy profile. Do not simply stop a needed medication without medical guidance; instead, ask your clinician to plan the switch.

Cost Comparison

Both lisinopril and losartan have been available as generics for many years and are generally among the more affordable prescription medications. Both frequently appear on pharmacy discount generic lists and are typically placed on low insurance copay tiers, so cost is rarely the deciding factor between them. Actual prices vary by pharmacy, location, insurance, and discount program and change over time, so verify current pricing with your own pharmacy or a discount-card tool rather than relying on a fixed figure. For broader strategies on managing medical expenses, see our healthcare costs guide.

Which Medication Is Right for You?

Your prescriber is best positioned to decide whether lisinopril or losartan fits your situation, but understanding the general logic helps you take part in the decision. An ACE inhibitor like lisinopril may be favored when there is a strong indication such as heart failure or recent heart attack, where the class has extensive outcome data. An ARB like losartan is often preferred when someone cannot tolerate an ACE inhibitor’s cough, when angioedema risk is a concern, when diabetic kidney disease is present, or when a clinician wants the lower cough and angioedema profile from the start.

Historically, many patients were started on an ACE inhibitor and switched to an ARB if a cough or other intolerance developed, and that remains a common and reasonable path. Current guidelines generally treat the two classes as comparable first-line options for straightforward high blood pressure, with the choice individualized. The important message is that both are effective and switching between them is straightforward when done under medical supervision.

For related medication information, see our article on how long amlodipine takes to work, which covers another commonly prescribed blood pressure medication, and our comparison of Prozac vs Zoloft, which follows a similar format if you are exploring options for mood management.

Frequently Asked Questions

Can you take lisinopril and losartan together?

Taking an ACE inhibitor and an ARB together is generally not recommended. Clinical trials found that combining the two classes increased the risk of side effects such as high potassium, low blood pressure, and kidney impairment without meaningful benefit. Most guidelines advise using one or the other, not both. Only a prescriber should decide on any combination therapy.

Which is better for kidney protection, lisinopril or losartan?

Both protect the kidneys by easing pressure inside the kidney’s filtering units. Losartan has specific evidence for slowing kidney disease in people with type 2 diabetes, and ACE inhibitors like lisinopril also have strong kidney-protective evidence. Your clinician will choose based on your kidney health, diabetes status, potassium levels, and how you tolerate each drug.

How long do lisinopril and losartan take to work?

Both begin lowering blood pressure within hours of the first dose, but the full effect builds over a few weeks. Your clinician will usually recheck your blood pressure a few weeks after starting or changing the medication and will monitor kidney function and potassium. Do not judge effectiveness from a single reading.

Can you drink alcohol while taking lisinopril or losartan?

Alcohol can further lower blood pressure and increase dizziness and lightheadedness, particularly when you first start either medication or after a dose change. If you drink, moderate intake is generally the guidance, and heavy or binge drinking should be avoided because it works against blood pressure control. Ask your clinician about what is appropriate for you.

What should I do if I get a cough on lisinopril?

A dry, persistent cough is a known ACE inhibitor effect. Do not simply stop the medication; contact your prescriber, who can confirm whether the cough is drug-related and, if so, may switch you to an ARB such as losartan, which usually resolves the cough within a few weeks.

The Bottom Line

The lisinopril vs losartan comparison comes down to two closely related medications that lower blood pressure through the same hormonal system by different mechanisms. Both are effective, affordable, and well studied, and both can protect the kidneys and heart in the right patients. The most practical difference is the dry cough that some people get on lisinopril but rarely on losartan, along with the somewhat higher angioedema risk with ACE inhibitors. Beyond that, specific situations, such as heart failure, diabetic kidney disease, or a prior reaction, may favor one over the other. Both share a risk of high potassium and both are off-limits in pregnancy. Your prescriber can weigh these factors with you, and switching between the two is straightforward when the first choice is not the right fit.

Sources

• U.S. Food and Drug Administration / DailyMed — prescribing information for lisinopril and losartan, including boxed warning on fetal toxicity and warnings on angioedema and hyperkalemia
• Mayo Clinic — ACE inhibitors and angiotensin II receptor blockers (ARBs) drug information and consumer guides
• Cleveland Clinic — ACE inhibitors and ARBs overviews
• MedlinePlus, U.S. National Library of Medicine (NIH) — lisinopril and losartan monographs
• American Heart Association / American College of Cardiology — guideline for the prevention, detection, evaluation, and management of high blood pressure in adults