Lisinopril and losartan are two of the most commonly prescribed blood pressure medications, and it’s easy to mix them up. They both act on the same hormone system, but they do it in different ways, and that difference shapes their side effects.
The main difference is how they work: lisinopril is an ACE inhibitor that lowers the amount of a blood-vessel-tightening hormone your body makes, while losartan is an angiotensin II receptor blocker (ARB) that stops that hormone from acting. Research shows they’re similarly effective at preventing heart attacks and strokes, but losartan is less likely to cause a dry cough or a rare type of swelling called angioedema.
Key takeaways
- Both are first-line options. The 2025 American Heart Association and American College of Cardiology guideline lists ACE inhibitors and ARBs among the first-line medications for high blood pressure.
- Effectiveness is similar, side effects differ. A study of nearly 3 million patients found no significant difference in cardiovascular outcomes, but ARBs had lower rates of cough and angioedema.
- Don’t combine or switch them on your own. Taking both together raises the risk of kidney injury and high potassium, and any switch should be directed by your prescriber.
What is the difference between lisinopril and losartan?
Both medications target the renin-angiotensin system, a hormone system that helps control blood pressure and fluid balance. The key hormone is angiotensin II, which tightens blood vessels and raises blood pressure. Lisinopril and losartan both reduce its effect, just at different steps.
How lisinopril works
Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor. It blocks the enzyme that turns angiotensin I into angiotensin II, so your body makes less of it. According to StatPearls, this relaxes blood vessels and lowers blood pressure.
That same enzyme also breaks down bradykinin, a substance that widens blood vessels. When ACE is blocked, bradykinin can build up, which researchers link to cough and angioedema (swelling beneath the skin, often in the face, lips, or throat).
How losartan works
Losartan is an angiotensin II receptor blocker (ARB). Your body still makes angiotensin II, but losartan blocks the receptors it would normally attach to. Because it doesn’t affect the ACE enzyme, it doesn’t cause bradykinin to build up in the same way. That’s the main reason ARBs are often considered when someone can’t tolerate an ACE inhibitor.
Lisinopril vs. losartan at a glance
This comparison draws on the FDA-approved labeling for lisinopril and losartan (Cozaar). Your prescriber decides the right medication and dose for you.
| Lisinopril | Losartan | |
|---|---|---|
| Drug class | ACE inhibitor | Angiotensin II receptor blocker (ARB) |
| Common brand names | Zestril, Prinivil | Cozaar |
| FDA-approved uses | High blood pressure, heart failure, and improving survival after a heart attack | High blood pressure, reducing stroke risk in people with high blood pressure and an enlarged heart, and diabetic kidney disease |
| Usual adult starting dose for blood pressure | 10 mg once daily (5 mg if taking a diuretic) | 50 mg once daily |
| Maximum dose for blood pressure | Up to 40 mg daily | Up to 100 mg daily |
| Dry cough | More common | Less common |
| Angioedema | Higher risk | Lower risk |
| Safe in pregnancy | No | No |
Which is better, lisinopril or losartan?
For most people with high blood pressure, neither is clearly better at protecting the heart. The best choice depends on your other health conditions and how well you tolerate the medication.
The largest head-to-head comparison to date, a 2021 multinational study in Hypertension, followed nearly 3 million people starting an ACE inhibitor or an ARB. Researchers found no statistically significant difference in heart attack, heart failure, or stroke. People taking ARBs, however, had significantly lower rates of angioedema, cough, pancreatitis, and gastrointestinal bleeding.
A prescriber may lean toward one medication based on factors like these:
- Heart failure or a recent heart attack: Lisinopril’s labeling includes both of these uses.
- An enlarged heart muscle (left ventricular hypertrophy): Losartan is FDA-approved to reduce stroke risk in people with high blood pressure and this condition, though its label notes evidence that this benefit may not apply to Black patients.
- Type 2 diabetes with kidney disease: Losartan is FDA-approved for slowing diabetic kidney disease, and the 2025 guideline update prefers either an ACE inhibitor or an ARB for people with protein in the urine or reduced kidney function.
- A history of ACE inhibitor cough or angioedema: An ARB such as losartan is often considered, with careful evaluation after any angioedema.
- Cost and coverage: Both are available as low-cost generics, so this is rarely the deciding factor.
Which is stronger, losartan or lisinopril?
Milligram amounts can’t be compared directly because the drugs work differently. Clinical guidance treats them as roughly comparable at standard doses: a case review of the 2025 AHA/ACC guideline lists lisinopril 10 mg and losartan 50 mg as standard doses within their drug classes. How much either one lowers your blood pressure depends on your dose and how your body responds.
If you’re already stable on lisinopril or losartan and simply need to keep taking it while you wait for an appointment, a board-certified physician can review your refill request online. Questions about switching or side effects are better handled in a visit with a provider.
Lisinopril vs. losartan side effects
Both medications are generally well tolerated, and many side effects overlap. The biggest differences involve cough and angioedema.
Dry cough
A dry, persistent cough is a known side effect of ACE inhibitors like lisinopril. According to the American College of Chest Physicians, it has been reported in 5% to 35% of people taking these medications. It can start within hours or months after beginning treatment, and it usually goes away within 1 to 4 weeks of stopping, though it can linger for up to 3 months. Cough is much less common with ARBs, which is one reason prescribers switch patients to losartan.
Angioedema
Angioedema is rare but serious. It causes swelling, most often in the face, lips, tongue, or throat, and it can affect breathing. Lisinopril’s label lists a history of angioedema as a reason not to take it. ARBs carry a lower risk, but they don’t remove it entirely.
Side effects both medications share
- Dizziness or lightheadedness: especially when you first start or after a dose increase, as blood pressure drops.
- High potassium (hyperkalemia): both drugs can raise potassium levels, so your provider may check blood work, particularly if you have kidney disease or take potassium supplements.
- Changes in kidney function: your provider may monitor kidney labs periodically.
- Risk during pregnancy: both carry an FDA boxed warning because drugs that act on this hormone system can harm a developing baby. Tell your provider right away if you become pregnant.
Switching from lisinopril to losartan: how dose conversion works
Switching from lisinopril to losartan is common, most often because of a cough. There’s no official conversion chart on either label, so your prescriber will choose a starting dose based on your current dose, your blood pressure readings, and your kidney function.
If you’re considering a switch, here’s what the process usually looks like:
- Talk to your prescriber first. Don’t stop lisinopril on your own, since your blood pressure can rise without treatment.
- Expect a direct swap. Your provider will typically tell you when to stop one and start the other, rather than overlapping them.
- Monitor your blood pressure at home. Readings over the first few weeks help your provider adjust your dose.
- Give a cough time to fade. An ACE inhibitor cough can take weeks to go away after stopping.
- Keep up with follow-up labs if your provider orders potassium or kidney function checks.
Can you take lisinopril and losartan together?
Generally, no. Combining an ACE inhibitor and an ARB is known as dual blockade, and research shows the risks usually outweigh any benefit.
The VA NEPHRON-D trial, published in the New England Journal of Medicine, tested this exact combination in people with type 2 diabetes and kidney disease. Adding lisinopril to losartan significantly increased the rates of high potassium and acute kidney injury, and the trial was stopped early over safety concerns. If you notice both medications on your medication list, contact your prescriber or pharmacist to confirm it’s intentional.
When to seek medical attention
Most side effects of these medications are mild, but some need prompt care. Contact your healthcare provider if you have:
- A persistent dry cough that bothers you or disrupts sleep
- Dizziness or fainting, especially when standing up
- Muscle weakness or an irregular heartbeat, which can be signs of high potassium
- Blood pressure readings that stay well above your goal despite taking your medication as prescribed
Call 911 or go to the nearest emergency room if you develop swelling of the face, lips, tongue, or throat, or have trouble breathing or swallowing.
Frequently asked questions
Is losartan the same as lisinopril?
No. They treat many of the same conditions and both act on the renin-angiotensin system, but lisinopril is an ACE inhibitor and losartan is an ARB. They aren’t interchangeable without guidance from your prescriber.
Is losartan safer than lisinopril?
For some people, losartan may be easier to tolerate. Research shows ARBs are linked to lower rates of cough and angioedema than ACE inhibitors, with similar heart and stroke protection. Both medications share other risks, such as high potassium and harm during pregnancy.
Why would a doctor switch me from lisinopril to losartan?
The most common reason is a dry cough from lisinopril. Other reasons include a history of angioedema (with careful evaluation) or a specific condition where losartan has an FDA-approved use, such as diabetic kidney disease.
Which is better for your kidneys, lisinopril or losartan?
Both can help protect kidney function in people with high blood pressure and kidney disease. The 2025 hypertension guideline prefers either an ACE inhibitor or an ARB for people with protein in their urine or reduced kidney function. Losartan specifically has FDA approval for diabetic kidney disease.
Can I stop taking lisinopril if I have a cough?
Talk to your prescriber before stopping. Suddenly going without blood pressure medication can let your blood pressure rise, and your provider can switch you to another medication, such as an ARB, so you stay protected.
Refilling your blood pressure medication
If you’re stable on lisinopril or losartan and can’t get a timely appointment with your regular provider, a board-certified physician can review your request online, and approved prescriptions are often sent to your pharmacy the same day. You’ll need to be physically located in a state where the reviewing physician is licensed at the time of your request. For ongoing high blood pressure management or questions about switching medications, virtual primary care through HealthSource Medical Associates can help. Get your prescription refill
Sources
- DailyMed, National Library of Medicine. Lisinopril Tablets: Prescribing Information
- DailyMed, National Library of Medicine. Cozaar (Losartan Potassium) Tablets: Prescribing Information
- Chen R, et al. Comparative First-Line Effectiveness and Safety of ACE Inhibitors and Angiotensin Receptor Blockers: A Multinational Cohort Study. Hypertension. 2021.
- Fried LF, et al. Combined Angiotensin Inhibition for the Treatment of Diabetic Nephropathy. New England Journal of Medicine. 2013.
- Dicpinigaitis PV. Angiotensin-Converting Enzyme Inhibitor-Induced Cough: ACCP Evidence-Based Clinical Practice Guidelines. Chest. 2006.
- Herman LL, et al. Angiotensin-Converting Enzyme Inhibitors (ACEI). StatPearls, NCBI Bookshelf.
- Pirahanchi Y, Sharma S. Physiology, Bradykinin. StatPearls, NCBI Bookshelf.
- American Heart Association. 2025 High Blood Pressure Guideline
- Updates in the 2025 AHA/ACC Hypertension Guideline. PubMed Central.
- Case-Based Applications of the 2025 AHA/ACC/Multispecialty High Blood Pressure Guideline. Hypertension.
This article is for informational purposes only and is not a substitute for professional medical advice.
This is not an emergency service. In an emergency, call 911 or go to the nearest emergency room.