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Lisinopril is a drug commonly used to treat high blood pressure. Also known as hypertension, high blood pressure is estimated to affect close to half the U.S. adult population—about 108 million people (Whelton, 2017). Left untreated, high blood pressure can lead to serious health problems, including kidney failure, stroke, and heart disease.
Lisinopril (also found under the brand name Zestril) is an angiotensin-converting enzyme (ACE) inhibitor. This class of drug works by relaxing blood vessels (essentially the equivalent of increasing a highway from one lane to four lanes, which helps alleviate traffic and congestion) (Messerli, 2018).
Along with lowering blood pressure, lisinopril has also been used to help treat other conditions, like heart failure and kidney disease (Lopez, 2020). Here’s more on what you need to know about lisinopril, its primary uses, and what side effects to be aware of before taking the drug.
What is lisinopril used for?
Lisinopril, also available under the brand names Prinivil and Zestril, is primarily used to treat high blood pressure but has also been approved by the U.S. Food and Drug Administration (FDA) for heart failure and heart attacks (FDA-b, n.d.).
Hypertension is a major risk factor for developing heart disease, the leading cause of death in the United States (CDC, 2017). Without proper treatment and lifestyle changes, high blood pressure can reduce blood flow to the heart and cause damage to blood vessels and organs (AHA, 2016). This can eventually lead to more serious complications, including heart attacks, stroke, and kidney disease.
There are many risk factors for developing hypertension, including diabetes, a family history of high blood pressure, obesity, and certain lifestyle choices (smoking, poor diet, lack of exercise) (Oparil, 2018). ACE inhibitors—like benazepril, lisinopril, and ramipril—are a class of medications used to treat hypertension.
Lisinopril comes in oral tablets available in 2.5 mg, 5 mg, 10 mg, 20 mg, 30 mg, and 40 mg doses (FDA-b, n.d.). It is typically taken once daily, with the dosage prescribed depending on your underlying condition. This drug is not safe for pregnant women and can cause severe injury or even death to a developing fetus (NLM, 2017). Let’s take a closer look at the main uses of lisinopril:
Hypertension, or high blood pressure, is when your blood pressure levels are consistently higher than normal. What exactly is normal? According to the American Heart Association (AHA), a normal blood pressure reading is under 120/80 mmHg (AHA, n.d.). High blood pressure can cause damage to blood vessels and organs, making your heart have to work extra hard to pump blood around your body. If your blood pressure climbs past the normal range, medications like lisinopril can help reduce your risk of developing heart disease. Healthcare providers will typically recommend lifestyle modifications in combination with blood pressure medication to treat hypertension and reduce the risk of cardiovascular disease (Oparil, 2018).
How lisinopril works in the body
When your heart is stressed, overworked, or has been damaged by chronic health conditions, it can lead to heart failure. The risk of developing heart failure dramatically increases if you have heart disease, uncontrolled high blood pressure, or have had any past heart attacks (AHA-a, 2017). ACE inhibitors like lisinopril are usually recommended alongside other treatments to help reduce the chance of death in patients with heart failure (Lopez, 2020).
A myocardial infarction, more commonly known as a heart attack, is a medical emergency that happens when a full or partial blockage prevents oxygen from reaching the heart muscle (AHA, n.d.). If given to a stable patient within the first 24 hours after a heart attack (depending on the type and severity), lisinopril has been found to improve survival rates (FDA-b, n.d.).
Potential side effects of lisinopril
There are a number of side effects or adverse reactions to be aware of before taking lisinopril. The most common ones include dry cough, dizziness, fainting, headaches, low blood pressure (hypotension), and chest pain (NLM, n.d.). It may also raise potassium levels in the body—a phenomenon known as hyperkalemia)—which can cause symptoms like weakness, muscle fatigue, nausea, and abnormal heart rhythms (NLM, n.d.). These abnormal heart rhythms can be dangerous, and in some cases, deadly.
While serious side effects aren’t as common, lisinopril can worsen kidney function and cause allergic reactions like angioedema—rapid swelling in the face, throat, and other areas of the body that can be potentially life-threatening (FDA-b, n.d.).
Combination therapy: lisinopril and hydrochlorothiazide
Lisinopril is frequently used in combination drug therapy, which is when multiple medications are taken at the same time. An example of this is the brand name drug Zestoretic, a combination drug of lisinopril and a diuretic called hydrochlorothiazide (HCTZ) (FDA-a, n.d.). Diuretics increase urine production in the body, and taken alongside lisinopril may cause other adverse effects like headaches, dizziness, blurred vision, fatigue, and cough.
While these side effects are typically mild and short-lived, there are certain groups of people—including those who have previously had reactions to lisinopril or HCTZ—who should not take lisinopril.
Beta blockers: how they’re used to treat heart conditions
Who should not take lisinopril
For the most part, lisinopril is safe and well-tolerated in many patients. But there are some who should avoid taking it altogether.
ACE inhibitors, including lisinopril, are not safe for pregnant women to take and have been found to be toxic to the fetus (NLM, n.d.). Since there isn’t enough evidence regarding the safety of lisinopril in nursing infants of mothers taking the drug, your healthcare provider may recommend other blood pressure-lowering medications (NLM, n.d.).
If you have ever had an allergic reaction to ACE inhibitors, a history of angioedema, kidney disease, hyperkalemia, hypotension, or liver disease, you should avoid taking this drug (FDA, 2014).
Drug interactions with lisinopril
Lisinopril should be used with caution while taking certain medications. If you have any underlying health conditions—like diabetes or kidney disease, for example—you may need to avoid lisinopril, depending on what other medications you’re taking. Below are some of the main drug interactions to watch out for (FDA, 2014):
- Diuretics (water pills): Lisinopril may cause blood pressure to drop even further in people taking diuretics at the same time. Other types of diuretics can affect potassium levels in the body, putting patients at higher risk of hyperkalemia if taken in tandem with lisinopril.
- Antidiabetics: Drugs used to treat diabetes, such as insulin and oral hypoglycemic medications, may increase the risk of hypoglycemia, or low blood sugar.
- Nonsteroidal anti-inflammatories (NSAIDs): Patients on NSAID therapy, especially those with poor kidney function, could be at risk for kidney failure when taking lisinopril at the same time. NSAIDs may also reduce the effectiveness of lisinopril.
- Aliskiren: Aliskiren is also used to treat high blood pressure. When combined with ACE inhibitors, aliskiren can cause low blood pressure, high blood potassium levels, and kidney failure.
- Lithium: Lithium, which is used to manage symptoms of bipolar disorder, can become toxic when combined with ACE inhibitors like lisinopril.
- Gold: Patients taking gold injections (also known as sodium aurothiomalate) to treat inflammatory diseases may experience adverse reactions—including flushing of the face, nausea, and low blood pressure—when taken at the same time as lisinopril.
Common risk factors for heart disease
Other things to avoid while taking lisinopril include alcohol, salt substitutes, and potassium supplements. This doesn’t include all the potential drug interactions with lisinopril. Talk with a healthcare provider before taking any type of ACE inhibitor, especially if you have other conditions or are taking multiple medications.
- American Heart Association (AHA-a). (2017, May 31). Causes of Heart Failure. Retrieved Oct. 15, 2020 from https://www.heart.org/en/health-topics/heart-failure/causes-and-risks-for-heart-failure/causes-of-heart-failure
- American Heart Association (AHA). (2016, October 31). Health Threats from High Blood Pressure. Retrieved Oct. 12, 2020 from https://www.heart.org/en/health-topics/high-blood-pressure/health-threats-from-high-blood-pressure
- American Heart Association (AHA-b). (2017, May 31). Treatment of a Heart Attack. Retrieved Oct. 15, 2020 from https://www.heart.org/en/health-topics/heart-attack/treatment-of-a-heart-attack
- American Heart Association (AHA). (n.d.). Understanding Blood Pressure Readings. Retrieved Oct. 12, 2020 from https://www.heart.org/en/health-topics/high-blood-pressure/understanding-blood-pressure-readings
- Kochanek, K. D., Murphy, S. L., Xu, J., & Arias, E. (2019). Deaths: Final Data for 2017. National Vital Statistics Reports, 68(9). Retrieved from https://www.cdc.gov/nchs/data/nvsr/nvsr68/nvsr68_09-508.pdf
- Lopez, E. O., Parmar, M., Pendela, V. S., & Terrell, J. M. (2020). Lisinopril. StatPearls. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK482230/
- Messerli, F. H., Bangalore, S., Bavishi, C., & Rimoldi, S. F. (2018). Angiotensin-Converting Enzyme Inhibitors in Hypertension: To Use or Not to Use? Journal of the American College of Cardiology, 71(13), 1474-1482. Retrieved from https://pubmed.ncbi.nlm.nih.gov/29598869/
- Oparil, S., Acelajado, M. C., Bakris, G. L., Berlowitz, D. R., Cifkova, R., Dominiczak, A. F., et al. (2018). Hypertension. Nature Reviews Disease Primers, 4, Retrieved from https://doi.org/10.1038/nrdp.2018.14. Retrieved from https://www.nature.com/articles/nrdp201814
- U.S. Food and Drug Administration (FDA). (June 2018). Highlights of Prescribing Information, ZESTRIL. Retrieved Oct. 15, 2020 from https://www.accessdata.fda.gov/drugsatfda_docs/label/2014/019777s064lbl.pdf
- U.S. Food and Drug Administration (FDA-a). (n.d.). ZESTORETIC (lisinopril and hydrochlorothiazide). Retrieved Oct. 15, 2020 from https://www.accessdata.fda.gov/drugsatfda_docs/label/2009/019888s045lbl.pdf
- U.S. Food and Drug Administration (FDA-b). (n.d.). ZESTRIL (lisinopril). Retrieved Oct. 15, 2020 from https://www.accessdata.fda.gov/drugsatfda_docs/label/2009/019777s054lbl.pdf
- U.S. National Library of Medicine (NLM). (2007, March 2). LABEL: lisinoprol- Lisinopril tablet. Retrieved Aug. 11, 2020 from https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=27ccb2f4-abf8-4825-9b05-0bb367b4ac07
- Whelton, P. K., Carey, R. M., Aronow, W. S., Casey, D. E., Collins, K. J., Himmelfarb, C. D., et al. (2017). 2017 Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension, 71(6). https://doi.org/10.1161/HYP.0000000000000065. Retrieved from https://www.ahajournals.org/doi/10.1161/HYP.0000000000000065
Yael Cooperman is a physician and works as a Senior Manager, Medical Content & Education at Ro.