Lisinopril vs Losartan: Which Is the Better Blood Pressure Medication?

Lisinopril and Losartan are two of the most-prescribed blood pressure medications in the world, and they treat high blood pressure through closely related but distinct mechanisms. Both are cheap, both are effective, and both protect the kidneys in diabetes. The biggest difference for most patients comes down to one common side effect: the cough.

Quick comparison at a glance

How they work

Both drugs target the renin-angiotensin system, which controls blood pressure and fluid balance.

Lisinopril is an ACE inhibitor. It blocks the angiotensin-converting enzyme (ACE), which prevents your body from converting angiotensin I to angiotensin II — a powerful vasoconstrictor. With less angiotensin II, your blood vessels relax and blood pressure drops.

Losartan is an ARB (angiotensin II receptor blocker). It allows angiotensin II to be made but blocks its action at the receptor. Same end result, different mechanism.

Effectiveness

For lowering blood pressure, both drugs are equally effective on average. Studies show similar reductions: about 8–14 mmHg systolic at typical doses. For most patients, either drug will work.

For specific conditions:

• Heart failure: ACE inhibitors (lisinopril) have stronger long-term mortality data. ARBs are used when ACE inhibitors aren't tolerated.
• Diabetic kidney disease: Both protect kidneys; losartan has the most direct evidence for type 2 diabetes nephropathy.
• Stroke prevention: Losartan has direct stroke-prevention data (the LIFE trial); ACE inhibitors have somewhat weaker evidence here.
• After heart attack: ACE inhibitors are first-line; ARBs are an alternative for ACE-intolerant patients.

The cough

The single most important difference between lisinopril and losartan: the cough.

5–35% of people on lisinopril (or any ACE inhibitor) develop a persistent dry cough. It's not dangerous, but it's annoying — described as "tickle in the throat" — and doesn't go away as long as you're on the medication. It can start within days or take months to develop.

The cough comes from bradykinin accumulation, a side effect of blocking ACE. Losartan and other ARBs don't affect bradykinin, so they don't cause this cough.

If you develop the lisinopril cough, switching to losartan usually resolves it within 1–4 weeks. This is the single most common reason for switching from an ACE inhibitor to an ARB.

Other side effects

Both drugs share these common side effects:

• Dizziness: Especially with the first few doses. Take at bedtime initially.
• Hyperkalemia (high potassium): Both can raise potassium levels. More likely with kidney disease, diabetes, or potassium-sparing diuretics.
• Kidney function changes: Mild creatinine increase is normal; major increases warrant evaluation.
• Low blood pressure (hypotension): Especially in dehydrated patients or those taking diuretics.

Angioedema (sudden swelling of face, tongue, throat) is rare but life-threatening with either drug. It's significantly more common with ACE inhibitors than ARBs (roughly 0.1–0.7% vs 0.1%). Black patients have higher risk on ACE inhibitors specifically — losartan is often preferred in this population.

Both drugs are contraindicated in pregnancy (Category D). They can cause severe fetal harm, especially in the second and third trimesters.

Cost comparison

Both are inexpensive generics:

• Generic lisinopril: $4–10 for 30 tablets — often $4 at major chain pharmacies
• Generic losartan: $4–15 for 30 tablets — slightly more expensive on average
• Brand-name Prinivil/Zestril (lisinopril): ~$50/month
• Brand-name Cozaar (losartan): ~$200/month

Generics are clinically identical to brand-name versions. There is no medical reason to take brand for either drug. Mark Cuban's Cost Plus Drugs lists generic lisinopril at around $4/month and generic losartan at around $5/month.

Which one should you take?

Lisinopril is often the first choice when:

• You have heart failure (stronger evidence base)
• You've had a recent heart attack
• You don't have a history of cough or angioedema with ACE inhibitors
• Cost is the main factor (slightly cheaper generic)

Losartan is often preferred when:

• You've developed a cough on lisinopril or another ACE inhibitor
• You've had angioedema on an ACE inhibitor
• You're Black (higher angioedema risk on ACE inhibitors)
• You have type 2 diabetes with kidney disease (LIFE trial evidence)
• You're at high stroke risk

Many doctors start with lisinopril (cheaper, more evidence) and switch to losartan if side effects develop. About one in four patients ends up switching.

Frequently asked questions

Can I switch from lisinopril to losartan?

Yes, switching is straightforward. Your doctor will start losartan at a typical dose (often 50mg) the day after stopping lisinopril. Most patients transition without issues. The lisinopril cough usually resolves within 1–4 weeks.

Why does lisinopril cause a cough?

ACE inhibitors block both angiotensin conversion and the breakdown of bradykinin, a peptide that accumulates in the airways and triggers a cough. Losartan and other ARBs don't affect bradykinin, so they don't cause this side effect.

Are lisinopril and losartan safe for kidneys?

Both protect kidneys in diabetes, despite mild changes in creatinine. A small initial increase (up to 30%) is expected and not concerning. Larger increases need evaluation. Both drugs require monitoring kidney function and potassium periodically.

Can I take lisinopril or losartan with food?

Both can be taken with or without food. Lisinopril is sometimes preferred at bedtime to minimize dizziness. Consistency matters more than timing — pick a time and stick to it.

What's the difference between losartan and valsartan?

Both are ARBs in the same class with similar effects. Valsartan is dosed differently (typically 80–320mg once or twice daily). Losartan is more often used for hypertension; valsartan has additional indications including heart failure and post-MI use. Switching between them is straightforward.

Related reading:

• Generic vs Brand Name Drugs: $300B Question
• 7 Ways to Cut Prescription Drug Costs in Half (2026)
• Cheapest Prescriptions Without Insurance 2026