Lisinopril: Effective Blood Pressure Control and Heart Protection
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Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor prescribed primarily for the management of hypertension, heart failure, and post-myocardial infarction care. As a first-line antihypertensive agent, it works by inhibiting the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor, thereby reducing peripheral vascular resistance and decreasing cardiac afterload. Its well-established efficacy, favorable safety profile, and cardioprotective benefits make it a cornerstone in cardiovascular pharmacotherapy. Clinical evidence supports its role in slowing the progression of diabetic nephropathy and reducing mortality in high-risk cardiovascular patients.
Features
- Active ingredient: Lisinopril
- Drug class: Angiotensin-converting enzyme (ACE) inhibitor
- Available formulations: Oral tablets (2.5 mg, 5 mg, 10 mg, 20 mg, 30 mg, 40 mg)
- Bioavailability: Approximately 25%
- Half-life: 12 hours
- Time to peak concentration: 7 hours
- Excretion: Primarily renal
- Pregnancy category: D (contraindicated in second and third trimesters)
Benefits
- Effectively lowers systolic and diastolic blood pressure through vasodilation
- Reduces mortality in patients with congestive heart failure and left ventricular dysfunction
- Slows progression of diabetic nephropathy and reduces proteinuria
- Provides cardioprotective effects following acute myocardial infarction
- Demonstrates once-daily dosing convenience for improved adherence
- Shows neutral metabolic effects on glucose and lipid parameters
Common use
Lisinopril is indicated for the treatment of hypertension, either as monotherapy or in combination with other antihypertensive agents. It is prescribed for management of heart failure to improve survival and reduce hospitalization when used concomitantly with diuretics and digitalis. Following acute myocardial infarction, lisinopril is administered to stable patients within 24 hours to improve survival. Additionally, it is used for renal protection in hypertensive patients with type 2 diabetes mellitus and microalbuminuria or proteinuria.
Dosage and direction
The initial dosage for hypertension in adults not taking diuretics is 10 mg once daily, which may be increased to 20-40 mg daily based on blood pressure response. For heart failure, starting dose is 2.5-5 mg daily under close medical supervision, with gradual titration to a maximum of 40 mg daily. Post-myocardial infarction patients typically begin with 5 mg within 24 hours of onset, followed by 5 mg after 24 hours, 10 mg after 48 hours, and then 10 mg daily. Dosage adjustment is necessary in renal impairment: for creatinine clearance 10-30 mL/min, initial dose is 5 mg daily; below 10 mL/min, initial dose is 2.5 mg daily. Tablets should be taken at the same time each day, with or without food.
Precautions
Monitor blood pressure regularly during initial therapy and after dosage adjustments. Assess renal function and serum potassium before initiation and periodically during treatment. Exercise caution in patients with renal artery stenosis, collagen vascular diseases, or those undergoing major surgery. Avoid use in patients with aortic stenosis or outflow obstruction. Patients should maintain adequate hydration and report symptoms of infection (sore throat, fever) promptly. Angioedema may occur at any time during therapy, requiring immediate discontinuation. Regular monitoring of white blood cell counts is advised in patients with autoimmune diseases.
Contraindications
History of angioedema related to previous ACE inhibitor therapy. Hypersensitivity to lisinopril or any component of the formulation. Concomitant use with aliskiren in patients with diabetes mellitus. Pregnancy, particularly second and third trimesters, due to risk of fetal injury and death. Bilateral renal artery stenosis or stenosis in a solitary kidney.
Possible side effect
- Common: Cough (persistent, dry; 5-20% of patients), dizziness (5-10%), headache (5%)
- Less common: Fatigue (3%), nausea (2%), orthostatic hypotension (2%)
- Serious: Angioedema (0.1-0.5%), hyperkalemia (1-5%), renal impairment (2%)
- Rare: Neutropenia/agranulocytosis, hepatic failure, pancreatitis
- Dermatological: Rash (1%), photosensitivity
- Metabolic: Hypoglycemia in diabetic patients
Drug interaction
- Diuretics: Potentiates hypotensive effect; risk of first-dose hypotension
- Potassium-sparing diuretics/potassium supplements: Increased risk of hyperkalemia
- NSAIDs: May reduce antihypertensive effect and worsen renal function
- Lithium: Increased lithium levels and toxicity risk
- Oral hypoglycemics: Enhanced hypoglycemic effect
- Gold injections: Nitritoid reactions reported
- Aliskiren: Contraindicated in diabetic patients due to increased adverse events
Missed dose
If a dose is missed, take it as soon as remembered unless it is nearly time for the next scheduled dose. Do not double the dose to make up for a missed dose. Maintain regular dosing schedule; inconsistent dosing may lead to inadequate blood pressure control. If multiple doses are missed, contact healthcare provider for guidance on resumption of therapy.
Overdose
Symptoms include severe hypotension, bradycardia, circulatory shock, hyperkalemia, and renal failure. Management involves supportive care with volume expansion with normal saline for hypotension. Atropine may be administered for bradycardia. Hemodialysis effectively removes lisinopril from circulation. Monitor electrolyte balance and renal function closely. Angiotensin II infusion may be considered in severe cases unresponsive to conventional therapy.
Storage
Store at controlled room temperature (20-25°C or 68-77°F) in original container. Protect from moisture and light. Keep tightly closed. Do not store in bathroom or damp areas. Keep out of reach of children and pets. Do not use if tablets show signs of discoloration or deterioration. Properly discard expired medication.
Disclaimer
This information is for educational purposes only and does not constitute medical advice. Individual response to medication may vary. Consult a qualified healthcare professional before starting, changing, or discontinuing any treatment. Do not self-medicate. The prescribing physician should consider individual patient factors including comorbidities, concomitant medications, and renal function. Regular monitoring and follow-up are essential for safe and effective therapy.
Reviews
Clinical trials demonstrate lisinopril’s efficacy with 60-70% of hypertensive patients achieving blood pressure control. Meta-analyses show 20% reduction in stroke risk and 15% reduction in myocardial infarction among treated patients. In heart failure trials, lisinopril reduced mortality by 16% compared to placebo. Long-term studies indicate preserved renal function in diabetic patients with 50% reduction in proteinuria. Patient satisfaction surveys report high adherence rates due to once-daily dosing and generally favorable side effect profile, though cough remains a frequent reason for discontinuation in 5-10% of patients.