Medically reviewed by, Russell Braun RPH
Medications can be so confusing. Certainly, pronouncing them is bad enough how can you remember what they all do? In addition, trying to remember what class of drug they fall into can be overwhelming.
Likewise, lisinopril is no exception. According to Medicine.net, lisinopril is the third most prescribed drug in the United States.
1. What type of blocker is lisinopril?
Lisinopril is used to treat high blood pressure, heart failure and kidney problems that can be due to diabetes. Lisinopril is an angiotensin converting enzyme (ACE) inhibitor, which is another name for a blocker in the drug world. It is not a beta blocker. So, what does all that jargon stand for?
2. What is an ACE inhibitor?
ACE inhibitors like lisinopril, block (or inhibit) angiotensin converting enzyme from doing its job. An enzyme is a substance produced by a living organism that causes a chemical reaction to happen. The ACE enzyme breaks down the hormone angiotensin I and as a result creates angiotensin II.
Angiotensin II is a potent vasoconstrictor. What does that mean? Vasoconstrictors cause your arteries that carry blood from your heart to your organs to constrict due to certain chemicals being present. When the arteries constrict blood pressure increases. This is just like if you pinch down on a garden hose, the pressure of the water coming out after the pinch is higher.
When there is less angiotensin II in the body, blood pressure is not as high. Therefore, ACE Inhibitors are very effective at treating high blood pressure. In addition, blocking the ACE enzyme has been shown to be beneficial in heart failure and protecting the kidneys of diabetic patients.
The table below shows the brand and generic names of commonly prescribed ACE inhibitors. Another great thing about these drugs is they are almost all available as generics, making them much more affordable.
|Lisinopril||Zestril & Prinivil|
Pharmacist quick tip
In general, medications with a generic name that ends in “pril” are ACE inhibitors.
3. Why does lisinopril have two brand names?
Lisinopril is actually the generic name of the compound that was first created by the drug manufacturer Merck. They were already selling another ACE inhibitor, enalapril when they created lisinopril. Merk offered Astra-Zeneca, another drug manufacturer, a deal to co-market lisinopril.
Astra-Zeneca gladly accepted the offer and started selling lisinipril by the brand name Zestril. Merk also sold lisinopril but it’s brand name was Prinivil.
Today generics and combination products of each brand exist.
Don’t forget combination drugs!
ACE inhibitors have been on the market for many years and have proven to be effective at treating high blood pressure. However, blood pressure can creep back up on people over time. Therefore, these drugs have been also manufactured and sold in combination pills with other blood pressure medications. They combine ACE inhibitors with drugs that work in a different way to bring blood pressure down.
There are many such combinations and they are not listed in the table. More information on combination drugs is provided below.
4. What is the difference between an ACE inhibitor and a beta blocker?
Like ACE inhibitors, beta blockers are medications used to control high blood pressure. They are also used in the following disease states:
- Angina (Chest pain)
- Abnormal heart rhythms
- Heart attack
- Heart failure
- Migraine prevention
The name beta blocker was given because these drugs block beta receptors. There are two types of beta receptors beta-1, mostly found in and around the heart and beta-2 found throughout the body. Beta receptors are found in nerve cells of the heart, smooth muscle around blood vessels, airways, kidneys and in the eye. Having so many places where beta receptors exist help beta blockers have all of the different effects they can have.
When beta blockers are present at beta receptors they prevent the neurotransmitters epinephrine (also known as adrenaline) and norepinephrine from acting on the beta cells. This leads to different effects depending on the type of cells the beta blocker is working on. The table below describes some effects this has in the body.
|Body Site||Beta Blocker Response|
|Heart||Slow heart rate|
Decrease pumping force
|Blood vessels||Relax muscle opening up inside of artery|
|Airways||Prevent muscles from relaxing making airways tighten|
|Kidneys||Reduce blood flow through kidney|
|Eyes||Relax muscle reducing pressure in the eye|
Selective and nonselective Beta Blockers
Having a beta blocker that primarily works on the heart and not the rest of the bodies beta receptors can be important. Beta blockers that only work on beta-1 receptors are referred to as cardioselective. These beta blockers would only have the affects of slowing heart rate and decreasing pumping force.
Cardio Selective Beta Blockers
|Metoprolol succinate||Toprol XL|
Beta blockers that work on both beta-1 and beta-2 are referred to as nonselective. They could be expected to have any of the effects listed in the table above. This could be a problem for someone with a lung issue such as asthma if the beta blocker made the airways tighten.
Non Cardio Selective Beta Blockers
Pharmacist quick tip
In general, medications with a generic name that ends in “olol” are beta blockers.
5. Lisinopril vs. other blood pressure drugs
First of all, there are over two hundred drugs used to treat high blood pressure. Certainly, lisinopril is one of the most popular and is used by millions worldwide. Therefore, lisinopril gets confused with beta blockers and many other types of drugs. To add to this confusion, lisinopril is sold as a combination medicine. Other common lisinopril questions include:
Is lisinopril a beta blocker or a calcium channel blocker?
A calcium channel blocker does just what it says. By blocking calcium channels they prevent calcium from moving into cells during a process called depolarization. This happens in heart and blood vessel cells and because of the blockage makes it easier for the heart to pump blood and the blood vessels open up, which decreases blood pressure.
Maybe the two most common calcium channel blockers are Norvasc (amlodipine) and Cardizem (diltiazem).
Is lisinopril a diuretic or a beta blocker?
A diuretic, sometimes also referred to as a water pill, works on the kidneys. These drugs increase the amount of salt that is moved into the urine. Once that happens the water in your blood moves into the urine as well because the salt draws it out of the blood. When there is less volume of blood in your arteries the pressure drops.
Many diuretics are available the two most common are Hydrodiuril (hydrochlorthiazide) and Lasix (furosemide).
Classes of blood pressure medications
|Beta-blockers||Calcium channel blockers|
|Angiotensin II blockers||Alpha blockers|
Each drug class listed above has from one to dozens of individual medications. With all these choices how does a doctor know which one to use?
6. Is lisinopril best for you?
Lisinopril has been shown to be effective at treating blood pressure, but wouldn’t no medication be better?
This can be a reality for patients who eat a balanced diet, limit salt intake and exercise regularly. Patients who commit to these changes can often remove the need for medications to treat high blood pressure. Thus, eliminating the risks associated with drug side effects.
When medication is required
Some patients will require medications for high blood pressure due to risk factors or genetic predispositions the problem.
When that is the case, the doctor should follow this process:
Start with evidence
Your doctor should be choosing a blood pressure medication for you based on evidence of what has worked well with few side effects. If the medication has been shown effective in other things besides high blood pressure that is an added bonus.
That is why lisinopril is so popular!
Numerous studies have shown clear benefits of using lisinopril. In fact, blood pressure treatment has become a place where doctors should follow guidelines for how to treat patents.
The most authoritative source is the Eighth Joint National Committee (JNC 8) Hypertension Guidelines. This committee of doctors and experts from around the world look at the evidence that is out there for treating high blood pressure and determine what drugs should be used and when.
The most recent JNC 8 guidelines are from 2014 and they offer doctors several choices for which drugs to choose to treat high blood pressure. The basic recommendations are listed below.
- Thiazide diuretics
- ACE inhibitors
- Angiotensin receptor blockers
- Calcium channel blockers
- Thiazide diuretics
- Calcium channel blockers
Any race with kidney disease
- ACE inhibitors
- Angiotensin receptor blockers
ACE Inhibitors, such as lisinopril, are first line treatment suggestions in almost all patients except blacks with no kidney disease. Beta blockers are not recommended as first line treatment options. Every person is unique so treatment choices may vary, however these guidelines are a starting point for your doctor.
7. Can you take lisinopril with other blood pressure drugs?
Many people will need to take more than one drug to control high blood pressure. Using medications that act on different sites in the body can be an effective way to bring blood pressure under control. This is another reason lisinopril is such a widely used medication.
Upon starting a medication that lowers blood pressure, your body may react by having a rebound effect. This rebound fights against the blood pressure lowering effects of the medication. Thus, a second or even a third medication could be required.
Increase the dose?
Before adding a second or third medication the dose of the first should be increased to control blood pressure. Many people can be maintained by increasing to an optimal dose of one medication for years before a second drug needs to be added. The downside to this approach is the risk of side effects increases as the dose goes up.
According to the JNC-8 guidelines blood pressure should be assessed monthly until the goal blood pressure has been reached. This means monitoring at home should be done in addition to the readings taken at the doctors office. Bullet journaling medication effects can be very valuable for assessing how the drug is working for you.
More than one drug
Taking more than one medication for high blood pressure allows you to control different systems in the body that could be causing the problem. This also allows lower doses of both medications which can lower side effect risks.
When more than one drug is prescribed, an ACE inhibitor like lisinopril will more than likely be one of the options. ACE inhibitors are so popular they are almost always a first, second or third line choice.
Great news! Lisinopril is available as a combination medication.
The manufacturer of lisinopril makes a tablet that also contains hydrochlorothiazide (HCTZ). This drug is a diuretic and as noted above increases urination by pulling salt and water into the urine.
The combination is referred to as lisinopril/HCTZ and comes in the strengths listed below. The lisinopril component is listed first and the HCTZ last.
8. Lisinopril drug interactions
Lisinopril can have interactions with other drugs. This is why it is important that you keep a list of your medications and share it with your doctor and pharmacist. Every time a medication is added the list should be updated. Finally, the list should be reviewed by your doctor at each appointment to ensure your list matches theirs.
Below are some common drugs that interact with lisinopril. That certainly does not mean you can’t take these medications together, just that your doctor needs to be aware. If they know you are on both they can watch for the interaction and monitor it.
- Potassium supplements
- Other ACE inhibitors
- Angiotensin II receptor blockers (ARBs)
- Tekturna (aliskiren)
9. Lisinopril side effects
First of all, lisinopril normally has few side effects. However, as with any drug that can affect blood pressure some issues may surface upon starting the medication. Light-headedness during the first few days may present and make you think lisinopril is not for you. Typically, these symptoms will go away after a week or so.
Another common side effect of all ACE inhibitors is a dry, cough that does not bring up any phlegm. This side effect needs to be reported to your doctor right away so they can monitor. For many patients it will go away, but can take up to a month.
The most serious side effect of ACE inhibitors is called angioedema. This simply means swelling of the deeper layers beneath the skin. While this can happen anywhere on the body, it can be life threatening when it occurs in the head an neck area. Consequently, anyone on an ACE inhibitor should seek medical attention immediately if they noticed his side effect.
Furthermore, some other common side effects are listed below:
- Increased potassium levels
- Chest pain
- Increased Uric acid levels
- Sun sensitivity
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Share your story!
Have you used lisinopril or another ACE inhibitor? Likewise, tell us if you have tried a beta blocker. How well did either work for you? Please chime in below with your comments and thoughts below.