What is a good replacement for lisinopril? Exploring Your Options

October 9, 2025 •

4 min read

Nearly half of adults in the U.S. have hypertension (high blood pressure), a primary risk factor for cardiovascular disease [1.10.1, 1.10.3]. For those managing this condition, understanding medication options is crucial. If you're wondering, 'What is a good replacement for lisinopril?', there are several effective alternatives available.

Quick Summary

Lisinopril, an ACE inhibitor, is a common hypertension drug, but side effects like a persistent cough lead many to seek alternatives. Key replacements include ARBs, beta-blockers, calcium channel blockers, and diuretics.

Key Points

Lisinopril Side Effects: The most common reason to replace lisinopril is a persistent dry cough, which can affect up to 35% of users [1.2.1, 1.4.2].
ARBs are a Top Alternative: Angiotensin II Receptor Blockers (ARBs) like losartan and valsartan are often the first replacement choice as they work similarly but have a much lower incidence of cough [1.3.3].
Other Drug Classes: Other effective replacements include Calcium Channel Blockers (e.g., amlodipine), Beta-Blockers (e.g., metoprolol), and Diuretics (e.g., HCTZ) [1.2.1].
Medical Consultation is Essential: A patient should never switch medications without first consulting a healthcare professional to discuss risks and benefits [1.2.1, 1.3.3].
Lifestyle is Key: Lifestyle changes like diet (DASH diet), exercise, and sodium reduction are crucial for managing blood pressure, both with and without medication [1.11.2, 1.11.4].
Hyperkalemia Risk: Lisinopril can cause high potassium levels (hyperkalemia); alternatives like CCBs or certain diuretics may be preferred if this is a concern [1.2.3, 1.3.5].
Specific Patient Needs: The best alternative depends on the patient's full health profile, as some medications are better for those with co-existing conditions like heart failure or a prior heart attack [1.2.1].

Understanding Lisinopril and the Need for Alternatives

Lisinopril is a widely prescribed medication belonging to the angiotensin-converting enzyme (ACE) inhibitor class [1.6.5]. It works by relaxing blood vessels, which helps to lower blood pressure [1.6.5]. It's used to treat hypertension (high blood pressure), heart failure, and to improve survival after a heart attack [1.3.4, 1.6.4]. While effective, some individuals experience side effects that prompt them to search for a replacement.

Common Reasons for Switching from Lisinopril

The most cited reason for discontinuing an ACE inhibitor is a persistent, dry, tickling cough, which can affect up to 35% of patients [1.2.1, 1.4.2]. Other significant side effects that may require a medication change include:

Angioedema: A rare but serious allergic reaction causing swelling under the skin, which can be life-threatening [1.3.3, 1.3.4].
Hyperkalemia: An elevation of potassium levels in the blood, which can be dangerous, especially for individuals with kidney disease or diabetes [1.3.1, 1.3.5].
Dizziness and Hypotension: Particularly when starting the medication or with dose increases, lisinopril can cause dizziness due to a drop in blood pressure [1.3.4].
Impaired Kidney Function: The medication can affect renal function, requiring monitoring of blood urea nitrogen and serum creatinine [1.3.1].

Primary Pharmaceutical Replacements for Lisinopril

Any decision to switch medications must be made in consultation with a healthcare professional [1.2.1]. The most common and effective alternatives belong to different drug classes.

Angiotensin II Receptor Blockers (ARBs)

ARBs are often the first choice when replacing lisinopril, especially if the reason for switching is the characteristic ACE inhibitor cough [1.3.3]. ARBs work in a similar way to ACE inhibitors by affecting the renin-angiotensin system, but they block the action of angiotensin II at the receptor level, leading to a much lower incidence of cough (around 3%) [1.5.2, 1.3.3]. They offer similar cardiovascular and renal benefits as ACE inhibitors [1.3.3].

Examples of ARBs: Losartan (Cozaar), Valsartan (Diovan), Irbesartan (Avapro), Candesartan (Atacand), Olmesartan (Benicar), and Telmisartan (Micardis) [1.5.1, 1.5.2].

Calcium Channel Blockers (CCBs)

CCBs lower blood pressure by preventing calcium from entering the cells of the heart and arteries, causing blood vessels to relax and widen [1.7.4]. This class is another first-line option for hypertension and is effective without causing the cough associated with ACE inhibitors or affecting potassium levels [1.2.1, 1.2.3].

Examples of CCBs: Amlodipine (Norvasc), Diltiazem (Cardizem), Verapamil (Calan), and Nifedipine (Procardia) [1.7.2, 1.7.3].

Beta-Blockers

Beta-blockers work by lowering the heart rate and reducing the force of each beat, which in turn lowers blood pressure [1.6.4]. While not always a first-line choice for uncomplicated hypertension, they are particularly beneficial for patients who have had a heart attack or have heart failure [1.2.1, 1.6.2].

Examples of Beta-Blockers: Metoprolol (Lopressor, Toprol XL), Atenolol (Tenormin), Carvedilol (Coreg), and Nebivolol (Bystolic) [1.6.1, 1.6.5].

Diuretics (Water Pills)

Diuretics help the body eliminate excess sodium and water, reducing the total volume of blood in the arteries and thereby lowering pressure [1.6.4]. Thiazide diuretics are a first-line treatment option for hypertension [1.2.5]. They can sometimes be used as an alternative for patients who develop high potassium (hyperkalemia) on lisinopril, as diuretics can have the opposite effect [1.2.1].

Examples of Thiazide Diuretics: Hydrochlorothiazide (HCTZ), Chlorthalidone, and Indapamide [1.8.1, 1.8.3].

Medication Comparison Table


Feature	ACE Inhibitors (Lisinopril)	ARBs (e.g., Losartan)	Calcium Channel Blockers (e.g., Amlodipine)	Beta-Blockers (e.g., Metoprolol)
Mechanism	Blocks production of angiotensin II [1.6.5]	Blocks angiotensin II from binding to receptors [1.5.2]	Relaxes blood vessels by blocking calcium entry [1.7.4]	Lowers heart rate and heart's workload [1.6.4]
Common Side Effects	Dry cough, dizziness, high potassium [1.3.4, 1.4.2]	Dizziness, very low incidence of cough [1.3.3, 1.9.3]	Swelling in ankles (edema), headache, palpitations [1.2.1, 1.6.4]	Fatigue, slow heart rate, dizziness [1.6.4]
Key Advantage	Strong evidence for heart and kidney protection [1.2.1]	Similar benefits to ACE inhibitors with fewer side effects [1.9.4]	Does not cause cough or affect potassium levels [1.2.1]	Beneficial for patients with prior heart attacks or certain heart failure [1.2.1]

The Role of Lifestyle Modifications

Before or alongside medication, healthcare providers will recommend lifestyle changes. For some, these adjustments can be enough to control blood pressure, while for others, they complement the effects of medication [1.2.1].

Key lifestyle changes include:

Weight Reduction: Losing even a small amount of weight can significantly lower blood pressure [1.11.4].
Heart-Healthy Diet: The DASH (Dietary Approaches to Stop Hypertension) diet, rich in fruits, vegetables, and low-fat dairy, can lower blood pressure by as much as 11 mm Hg [1.11.2].
Sodium Restriction: Limiting sodium intake to under 1,500 mg per day can reduce blood pressure by 5 to 6 mm Hg [1.11.2].
Regular Physical Activity: Aiming for at least 150 minutes of moderate-intensity exercise per week can lower blood pressure by 5 to 8 mm Hg [1.11.2].
Limiting Alcohol and Quitting Smoking: Both smoking and excessive alcohol intake raise blood pressure [1.11.1, 1.11.3].

Conclusion: Making the Right Choice with Your Doctor

If you're asking, 'What is a good replacement for lisinopril?', the answer depends on your specific health profile, the reason for the switch, and other co-existing conditions. Angiotensin II Receptor Blockers (ARBs) are frequently the top choice for those experiencing the common ACE inhibitor cough [1.3.3]. However, calcium channel blockers, beta-blockers, and diuretics are all viable and effective alternatives [1.2.1]. The most important step is to have a thorough discussion with your healthcare provider to weigh the benefits and risks of each option and determine the best course of treatment for your hypertension. Never stop or change your medication without professional medical advice [1.3.3].

For more information on blood pressure medications, you can visit the American Heart Association.

Frequently Asked Questions

The most common replacement for lisinopril, especially due to cough, is a medication from the Angiotensin II Receptor Blocker (ARB) class, such as losartan (Cozaar) or valsartan (Diovan). ARBs provide similar benefits with a significantly lower risk of cough [1.3.3].

While not direct replacements for a prescription, lifestyle changes are a natural way to help lower blood pressure. These include weight loss, regular exercise, sodium restriction, and following a diet like the DASH diet. Some supplements show promise but must be discussed with a doctor before use [1.2.1, 1.11.2].

No, you should not stop taking lisinopril or any blood pressure medication without consulting your healthcare provider. Abruptly stopping can cause your blood pressure to rise and increase your risk of heart attack or stroke [1.3.3, 1.6.3].

After stopping an ACE inhibitor like lisinopril, the associated cough typically resolves within 1 to 4 weeks. In some cases, it may linger for up to 3 months [1.4.1, 1.4.3].

Yes, ACE inhibitors and ARBs are generally considered to work equally well in lowering blood pressure and providing similar cardiovascular and renal benefits. ARBs are often preferred if a patient experiences side effects from an ACE inhibitor [1.9.2, 1.9.4].

Both drug classes target the renin-angiotensin system. ACE inhibitors, like lisinopril, block the production of angiotensin II. ARBs, like losartan, block angiotensin II from binding to its receptors. The primary practical difference for patients is that ARBs have a much lower incidence of causing a dry cough [1.6.5, 1.5.2, 1.3.3].

Dizziness can be a side effect of any medication that lowers blood pressure, especially when starting treatment or increasing the dose [1.3.4]. However, if the dizziness persists, your doctor may suggest a different medication or adjust your dosage [1.3.4].