Which Is Better? A Pharmacist Explains

What Is High Blood Pressure?

High blood pressure in adults is defined as blood pressure above 130/80 millimeters of mercury (mm Hg). It is the most common cause of heart disease and early death worldwide. Hypertension is very common in the United States. It’s estimated that close to half of American adults (45%) have it. High blood pressure can be genetic, meaning it runs in families.

In addition, lifestyle factors like the following can contribute to high blood pressure:

If it’s untreated or not well-controlled, hypertension increases the risk of conditions such as:

Keep in mind that not all cases of high blood pressure require medications. However, medication may be an essential part of your treatment plan. You and your provider can help decide the best course of action for you.

Dosage

Individual health factors, such as age, underlying medical conditions, and other medications used, play a role in selecting the appropriate dosage.

Lisinopril is usually given in doses of 10 to 40 mg per day for adults, either once or twice a day.

Children and people with the following conditions will start with a lower dose of lisinopril:

• Impaired kidney function: The starting dose is 2.5 or 5 mg daily, depending on kidney health. A lower dose is needed because the kidneys remove lisinopril from the body. If they’re not working well, lisinopril levels will build up.
• Taking diuretics: The starting dose is 5 mg because taking diuretics with lisinopril can cause a dramatic drop in blood pressure.

The usual dose of amlodipine for adults is 5 to 10 mg per day. Because it lasts long in the body, it only needs to be taken once a day.

Children and people with the following conditions will start with a lower dose of amlodipin, as follows:

• Impaired liver function: The starting dose is 2.5 mg daily. Amlodipine is broken down in the body by the liver, so if it’s not working well, amlodipine levels will increase.
• Older adults and those with lower body weight: The starting dose is 2.5 mg daily because people in these groups may process amlodipine differently or more slowly.

Both amlodipine and lisinopril are taken by mouth and are available in tablet and liquid formulations.

Side Effects and Safety Considerations

There are some significant side effects to be aware of if your healthcare provider prescribes amlodipine or lisinopril.

Amlodipine may cause the following side effects:

• Constipation
• Dizziness
• Fatigue
• Flushing
• Headache
• Heart palpitations
• Nausea
• Stomach pain
• Swelling of legs or hands

Lisinopril may cause the following side effects:

• Dizziness
• Dry cough
• Headache
• Hyperkalemia (high potassium levels)
• Hypotension (low blood pressure)
• Rarely, angioedema (swelling under the skin, usually around the face, that can block the airway and cause death)

There are also safety considerations for specific groups of individuals, including the following:

• Older people: Lower doses of amlodipine are typically used for people over age 65 because amlodipine is cleared from the body more slowly in this population.
• Pregnant people: Lisinopril should not be used during pregnancy because it can cause injury or death to a fetus. Amlodipine should be used cautiously, if at all, during pregnancy. It’s been shown to cause harm to the fetus in animal studies, so it should only be used if the benefits of treatments outweigh the risks.
• Those who breastfeed: People who take amlodipine should not breastfeed.

Interactions and Contraindications

There are some critical drug interactions to keep in mind if you take either amlodipine or lisinopril.

Amlodipine may interact with the following medications:

• Antimicrobial medications: Medicines that interact with amlodipine include the antifungal ketoconazole and the antiviral ritonavir. Taking amlodipine with these medicines may result in very low blood pressure (hypotension) or swelling.
• Enzyme inhibitors: Amlodipine levels may increase if taken with medicines that block liver enzymes called cytochrome p450 enzymes.
• Simvastatin: The dosage of amlodipine needs to be reduced when used in combination with simvastatin, a cholesterol medication (brand name Zocor).

Lisinopril can interact with the following medications:

• Diuretics (water pills): Taking these with lisinopril can cause hypotension or hyperkalemia.
• Insulin and other diabetes medicines. Taking these with lisinopril can cause blood sugar to get too low (hypoglycemia).
• Nonsteroidal anti-inflammatory drugs (NSAIDs): If older people or those with kidney problems take these with lisinopril, they may develop kidney failure.
• Tekturna (aliskiren): This blood pressure medicine should not be taken with lisinopril by people with diabetes or kidney problems.
• Lithium: Lithium is a medication used for bipolar disorder. Taking it with lisinopril can cause lithium toxicity, which can cause digestive symptoms like nausea and vomiting, followed by neurological symptoms such as dizziness and coma.

Lisinopril should not be taken by people who are pregnant or who have a history of angioedema (swelling).

Consult your healthcare providers for personalized advice on managing drug interactions and adjusting treatment plans. Keep all of your providers and your pharmacist up-to-date on your medication regimen for optimal safety.

Choosing Between Amlodipine and Lisinopril

There are many factors to consider when choosing between amlodipine and lisinopril. Some of these include:

Effectiveness

Amlodipine provides better 24-hour blood pressure control. According to some research, lisinopril mainly helps during the daytime. Race may play a role in effectiveness, with calcium channel blockers (such as amlodipine) recommended as first-line treatment for Black Americans.

Side Effects Profile

A large study of over 30,000 people with hypertension found that people were more likely to stick with amlodipine than lisinopril. The higher drop-out rate for lisinopril may be due to its common side effects, like a dry cough. It could also be due to rare side effects like swelling (angioedema) that may occur more often with lisinopril than amlodipine.

Cost

Since both amlodipine and lisinopril tablets are available as generic medicines, they’re likely to be the same or similar in cost for people with prescription insurance. If you don’t have insurance, discuss costs with your pharmacist to see which medicine fits your budget best. Liquid amlodipine (Katerzia and Norliqva) and liquid lisinopril (Qbrelis) are not available as generics, so they are more expensive.

If you take brand-name medications like these, check the manufacturer’s website for coupons and discounts. Many of these can be used along with insurance to lower your costs.

How to Take Them

Both medicines can be taken by mouth in tablet form or as liquids. Liquids are ideal for people with trouble swallowing or using a feeding tube but may be more expensive. Depending on how you respond to it, lisinopril may have to be taken twice daily. Amlodipine’s effects last 24 hours.

In addition, both amlodipine and lisinopril are available in combination products, including other blood pressure medicines. Depending on your other medical conditions, one of these combinations may be right for you.

Remember that it may take several tries to determine the best treatment plan for your high blood pressure. The good news is that there are lots of treatment options available.

When managing this or any chronic condition, honest discussions with healthcare providers are crucial to making informed decisions regarding your health.

Other Treatments

Lifestyle changes are essential to lower blood pressure and are considered first-line therapy. “First-line therapy” means they are typically recommended before prescription medications for people with slightly elevated blood pressure. They can also help make your blood pressure medication more effective.

These interventions include the following:

• Achieving a healthy weight: Research shows that systolic blood pressure (the top number in a blood pressure measurement) drops a point for every 2 pounds lost.
• The DASH (Dietary Approaches to Stop Hypertension) diet: This low-fat diet includes fruits, vegetables, dairy, and whole grains.
• Exercise: The best evidence suggests 150 minutes a week of aerobic exercise (“cardio”), such as walking.
• Increasing potassium: Increase potassium in the diet to 3,500 to 5,000 mg daily. Potassium-rich foods include fruits like apricots, raisins, bananas, and legumes like lentils and kidney beans.
• Limiting alcohol: This is less than one drink per day for females or two drinks daily for males. Completely removing alcohol from your diet is also an option.
• Reducing sodium (salt) in the diet: Try to reach a goal of less than 1,500 mg daily.

Summary

Amlodipine and lisinopril are common and effective first-choice medications for managing hypertension. They work to lower blood pressure in different ways and have distinct safety profiles, contraindications, and drug interactions.

Be sure to discuss your questions or concerns about these or other blood pressure treatments with your healthcare provider, pharmacist, or registered dietitian nutritionist, who can help you optimize your health.