What is better in treating high blood pressure: Lisinopril or Enalapril?

Faced with the need to select an effective antihypertensive drug, patients are often confused by the variety of these drugs and, at the same time, the similarity of their names.

Why does the doctor recommend drugs from one group of drugs to one patient - for example, those containing enalapril, while to others he prescribes Lisinopril, which, according to the instructions for use, is also an ACE inhibitor?

If your doctor recommends Lisinopril or Enalapril, which is better? And what are ACE (angiotensin-converting enzyme) inhibitors? Let's try to figure it out.

What are angiotensin-converting enzyme inhibitors?

Mentioned above is the mysterious enzyme ACE, the effect of which on blood vessels affects blood pressure. ACE, or angiotensin-converting enzyme, is indeed the most important enzyme that affects the RAAS (renin-angiotensin-aldosterone system), which in turn is “responsible” for blood pressure in the body.

Excessive activity of this system leads to pathological narrowing of blood vessels, which is manifested by an increase in blood pressure. Therefore, substances that can somewhat weaken the activity of the RAAS system by influencing the angiotensin-converting enzyme are called ACE inhibitors. Are all ACE blockers the same, are there any differences and which is better?

Types of ACE inhibitors

In modern therapeutic practice, 3rd generation ACE inhibitors are used, which may vary:

• pharmacokinetic properties (duration of action, features of excretion from the body, presence of an active metabolite);
• chemical structure.

The presence of a structure that interacts with the active center of ACE allows us to divide existing inhibitors into types:

• with the presence of a sulfhydryl group - these include Zofenopril, Pivalopril, Captopril;
• with the presence of a phosphoryl (phosphinyl) group - Fosinopril;
• with the presence of a carboxyl group - Perindopril, Ramipril, Lisinopril, Enalapril.

As we can see, both drugs of interest to us belong to the same variety, in the formula of which there is a carboxyl group. Its presence in the active substance, unlike the sulfhydryl group, does not provoke skin rashes, sleep disturbances and many other side effects. In addition, the presence of a carboxyl group affects the duration of action of the drug (18–24 hours). What is the difference between Lisinopril and Enalapril, which is better?

Classification of ACE inhibitors by physicochemical properties

What is the difference in composition between Lisinopril and Enalapril?

So, what can we say about the most popular representatives of ACE inhibitors - Lisinopril and Enalapril, which is better, what is the difference between these drugs?

1. The active ingredient of Enalapril is enalapril maleate.
2. The active ingredient of the second is Lisinopril dihydrate.
3. The first is a prodrug, that is, a substance that is converted into an active component (metabolite) during metabolism.
4. Lisinopril is not subject to metabolic processes in the body.

Indications for use

Let's take a closer look at the indications for use of the drugs in question.

Enalapril is used for:

• arterial hypertension (including renovascular);
• chronic failure.

Lisinopril is prescribed for:

• renovascular and essential hypertension (monotherapy and in combination);
• acute myocardial infarction (first day);
• chronic heart failure;
• diabetic nephropathy.

What's better? As you can see, the range of actions of Lisinopril is much wider than the scope of use of Enalapril.

Characteristics of Enalapril

Belongs to the second generation of ACE inhibitors. In addition to arterial hypertension, it is used to treat uncomplicated hypertensive crisis. This drug is well tolerated by the body. He underwent a number of clinical studies in which patients not only with arterial hypertension, but also with chronic heart failure, diabetes mellitus and coronary heart disease took part. In all cases, the drug confirmed its effectiveness and safety.

It contains the active ingredient enalapril. Release forms: tablets of 5, 10 and 20 mg.

The principle of its action is also based on the inhibition of angiotensin II. When taken regularly, the blood levels of potassium and renin, an enzyme produced by the kidneys and regulating blood pressure, increase. The blood vessels dilate, the resistance in them decreases, and the pressure decreases. The medication also has a pronounced cardioprotective effect - the life expectancy of patients with chronic heart failure who regularly take Enalapril increases.

Indications for use:

• arterial hypertension, incl. renal origin;
• chronic heart failure.

Contraindications:

• hypersensitivity;
• renal artery stenosis;
• history of angioedema;
• pregnancy, lactation period;
• childhood.

Side effects:

• dizziness, general weakness, confusion, headache;
• dry cough;
• from the cardiovascular system - decreased blood pressure, tachycardia, bradycardia, palpitations, chest pain;
• from the nervous system - mood swings, increased drowsiness;
• from the gastrointestinal tract - lack of appetite, dry mouth, nausea with vomiting, dyspeptic symptoms, abdominal pain;
• on the skin - allergic rashes, itching with urticaria.

Indications for use of Enalapril: arterial hypertension, incl. renal origin.

Is there a difference in the effect on the body?

Enalapril and Lisinopril, if the comparison is made according to parameters such as routes of evacuation from the body and metabolic characteristics, can be classified into different classes. In this regard, ACE inhibitors are divided into 3 classes:

1. Lipophilic drugs in which the elimination of inactive metabolites is carried out through the liver (which is typical for Captopril).
2. Lipophilic prodrugs, the elimination of active metabolites in this group occurs mainly through the liver and kidneys (Enalapril belongs to this class).
3. Hydrophilic medications that are not metabolized in the body, but are excreted unchanged through the kidneys (this class includes Lisinopril).

From this it becomes clear that the difference between Enalapril and Lisinopril is that the former, unlike the latter, is a prodrug. That is, after ingestion of the first drug, its biotransformation into an active metabolite occurs in the body - in this case, enalaprilat.

Transformation into enalaprilat occurs to a greater extent in the liver; extravascular tissues and the gastrointestinal mucosa are less actively involved in this process. It follows from this that the main burden during the metabolism of Enalapril falls on the liver. This means that patients with insufficient function of this organ may experience a significant decrease in the formation of active metabolites of ACE inhibitors, that is, a decrease in the effectiveness of the drug.

Which is better – Enalapril or Lisinopril

Chronic arterial hypertension requires urgent drug treatment, so specialists try to select an antihypertensive drug for the patient that is suitable for daily normalization of blood pressure.

The most popular drugs from the group of ACE inhibitors are Lisinopril and Enalapril, their action is aimed at inhibiting the production of angiotensin-converting enzyme. Thus, both drugs block the action of an enzyme that takes part in the biological processes that contribute to the narrowing of blood vessels.

These drugs are similar in their mechanism of action, but they have some differences in composition and dosage regimen, so the question arises for hypertensive patients, which is better, Lisinopril or Enalapril?

Composition and form of release of medicines

The drug formula Enalapril was created at the end of the 20th century as one of the analogues of Captopril. The drug belongs to the second generation ACE inhibitors. The chemical formula of Lisinopril was created in 1975, and it began to be produced later by a Hungarian pharmacological company.

Available in the form of white tablets with a division in the middle, in the amount of 10 pieces in a blister.

Enalapril is a chemically modified form of the drug, which in the body, as a result of metabolism, is transformed directly into the active component. The main active substance in the medication is enalapril maleate, in concentrations of 5, 10, 20 mg.

The drug also contains additional components, such as:

• sugar;
• lactose monohydrate;
• cellulose;
• talc;
• magnesium stearate;
• sodium bicarbonate.

Additional components may vary depending on the manufacturer.

The chemical components of Lisinopril are not affected by metabolic processes in the body. Thus, the active substance in the drug is lisinopril, in the form of dihydrate at a concentration of 10 mg.

Available in the form of single-color tablets, with cut edges and division on one side

The medicine contains the following auxiliary components:

• lactose monohydrate;
• corn starch;
• magnesium stearate;
• methylene chloride;
• povidone.

The additional components remain unchanged, only their dosage changes depending on the concentration of the active substance.

Differences in pharmacological properties

Enalapril has a vasoconstrictor effect, which reduces peripheral vascular resistance, reduces the load on the myocardium and stabilizes blood pressure.

Regular use of the medication produces the following effects on the body:

• elimination of spasm of arterial walls;
• normalization of systolic and diastolic pressure;
• reduces the load on the myocardium;
• restores blood circulation in the heart and kidney arteries;
• reduces the risk of progression of heart failure;
• produces a diuretic effect, thereby preventing fluid retention in the body;
• eliminates left ventricular hypotrophy;
• prevents the process of thrombosis.

The use of Lisinopril in the early rehabilitation period after an acute heart attack reduces the risk of death

The pharmacological properties of Lisinopril include direct inhibition of aldosterone production and an increase in the synthesis of prostaglandins. The drug has a similar effect on the body of a hypertensive patient as Enalapril, since all the effects are due to the effect on the renin-angiotensin-aldosterone system.

However, there is a difference between drugs in the mechanism of evacuation from the body, since the drugs belong to different classes of ACE inhibitors. Thus, Enalapril is a lipophilic prodrug in which the elimination of breakdown products occurs mainly through the kidneys, and to a lesser extent, through the liver.

More to read: Enalapril FPO and Enalapril - what is the difference

Lisinopril belongs to the hydrophilic group of medications that are not amenable to metabolic processes in the body. The active components are evacuated in unchanged form, mainly by the kidneys.

It follows from this that the distinguishing feature of Enalapril from Lisinopril is their distribution in the body after consuming the tablet. So Enalapril undergoes a process of biotransformation into the active metabolite - enalaprilat.

The transformation of the structural components of Enalapril occurs in the liver, which exposes it to additional functional load. Therefore, in hypertensive patients with liver dysfunction, a significant decrease in the conversion of active components may be observed, that is, a decrease in the therapeutic effectiveness of the drug.

Which medicine is better according to the method of administration?

Before choosing the best antihypertensive drug, patients have a question: what is the difference between drugs that are similar in almost all respects? One of the significant differences between Lisinopril and Enalapril is the dosage of the active substance and the dosage regimen, which, although they have minor differences, do affect the therapeutic effect.

Due to its prolonged action, Enalapril is more effective when taken in the morning

The duration of the hypotensive effect of Enalapril is on average 18 hours. To maintain normal blood pressure, it is recommended to take the drug 2 times a day, regardless of meal times. The medicine has a long period of evacuation from the body, so it is prescribed once or twice a day.

However, the drug has one main drawback: it enters the body in an inactive state, which means it requires activation of the active substance in the liver. The drug's chemicals can accumulate in fatty tissue, reducing its effectiveness in overweight patients.

Therefore, patients with a history of hypertension and type 2 diabetes should take the pills with caution.

A stable hypotensive effect when taking Lisinopril is observed after 1-2 months, which should be taken into account when increasing the dose

Lisinopril compares favorably with its analogue, since the hydrophilic class of the drug is well suited for the treatment of arterial hypertension. The duration of action is 24 hours, providing mild stabilization of blood pressure. It is enough to take the tablets once a day.

During treatment with both drugs, the following recommendations should be followed:

• monitor blood pressure levels throughout the day;
• monitor indicators of the state of the circulatory and excretory systems using laboratory tests;
• monitor the functional state of the heart and kidneys;
• Do not increase the dose of the drug yourself;
• It is recommended to take the minimum doses that maintain the hypotensive effect;
• Do not combine products with drinking alcohol.

Which drug is better in the treatment of hypertension?

Lisinopril has been used for the treatment of hypertension for many years, and at this time there is a lot of practical evidence proving the good effectiveness of the drug compared to other analogues.

In the treatment of arterial hypertension, both drugs showed good tolerance by the body.

A direct comparison of the therapeutic effectiveness of Lisinopril and Enalapril was carried out by monitoring blood pressure levels in patients undergoing antihypertensive treatment.

For qualitative control, it was customary to use the target blood pressure level (140/90 mm Hg), the dosage of the active substance was selected until the stated indicators were achieved.

Both medications reduced blood pressure to an optimal level, but the therapeutic effect of taking Lisinopril was more pronounced.

As a result of the study, it was revealed that with the same dosage and dosage regimen, Lisinopril has a longer duration of action.

Thus, both drugs have shown in practice high effectiveness and safety in the treatment of hypertension. The most advantageous feature of Lisinopril is its broader indications for use, so it can be prescribed to patients with obesity, viral hepatitis, and a history of acute heart attack.

Source: https://icvtormet.ru/medicamenty/chto-luchshe-enalapril-lizinopril

What is the difference in dosage and regimen?

According to the instructions for use, the dosage and regimen of Enalapril and Lisinopril are as follows.

The difference in the drug dosage regimen, as we see, is insignificant and does not answer the question - which of them is better.

Patient reviews

Antonina, 58 years old, Perm

I took Enalapril for hypertension at a dose of 10 mg every day. I liked the drug, it was well tolerated and did not cause any adverse reactions. But sometimes the pressure still increased and the dose had to be increased. Then the doctor prescribed Lisinopril in the same dosage: with it, the blood pressure remains stable throughout the day.

Peter, 62 years old, Tver

I have diabetes, and as a result I have problems with my kidneys, my blood pressure is constantly rising. The doctor prescribed Enalapril tablets, but after a few days I developed a cough. Then the doctor replaced it with Lisinopril. My condition returned to normal, my cough went away, my blood pressure stabilized, and there were no side effects.

Alexey, 72 years old, Samara

After a heart attack I take many different medications, incl. Enalapril. It helps with blood pressure and supports the heart. From time to time the doctor said to replace it with Lisinopril to avoid addiction. Both medications are well tolerated and help with blood pressure well.

Which is better according to reviews from receiving patients?

A study of reviews from patients who took both drugs shows that most of them do not see much of a difference and do not distinguish which is better from the drugs in question.

1. Those who have had to deal with side effects (mainly complain of a terrible paroxysmal cough) of Enalapril note that with the transition to Lisinopril, the picture of side effects has not changed.
2. Those who expressed dissatisfaction with the fact that in order to achieve a lasting therapeutic effect, ACE inhibitors have to be taken for a long time, note this drawback in both Enalapril and Lisinopril.
3. Those who are quite satisfied with the drug Enalapril due to its low price and - therefore - the ability to take tablets for a long period of time, write that they did not notice any changes when switching to Lisinopril.
   Many patients believe that medications should be changed periodically so that the body does not “get used to” them. Although scientific evidence of the development of resistance to ACE inhibitors has not been found.
4. An interesting warning came from one consumer who bought Lisinopril for her father from a dubious manufacturer instead of the original one. After taking the pill by an elderly man who had previously been successfully treated with Lisinopril, his condition sharply worsened, a hypertensive crisis occurred, and the ambulance arrived with difficulty bringing the man to his senses. An emergency doctor, looking at the packaging of Lisinopril, noticed that it is better not to buy drugs that are produced abroad, but are packaged at local pharmaceutical factories. These may be counterfeits.

From this information it is clear that the question - Enalapril or Lisinopril, which is better - patient reviews do not answer.

What do doctors think?

Doctors consider both drugs effective in controlling hypertension. But at the same time, they note that Lisinopril allows you to normalize blood pressure for a longer period, and it also has a pronounced therapeutic effect.

In turn, Enalapril appears to be more effective in the treatment of heart failure.

Based on these results, doctors find it difficult to answer which drug is more effective. They emphasize that the choice of drug and treatment regimen should be prescribed exclusively by a specialist after a complete examination of the patient and establishment of the picture of his disease. This will avoid negative consequences.

What is more effective according to doctors?

To find out the opinion of doctors, the authors of our site specifically conducted a survey among cardiologists, gastroenterologists, pulmonologists and other specialists. Reviews from doctors on the question of which is more effective - Lisinopril or Enalapril - make you think.

1. Some believe that Enalapril has a greater evidence base in the treatment of chronic heart failure.
2. Others summarize that the disadvantage of both drugs is the need for constant and high doses in order to achieve a therapeutic effect.
3. One cardiologist notes that only 10% of his patients observed a more or less tolerable effect from taking these ACE inhibitors.
4. When asked why most elderly patients prefer to maintain normal blood pressure with Enalapril or Lisinopril, there is only one answer - it’s all about the cheapness of these tablets (as patients joke, “we don’t care about fat today - we drink cheap Aprils...”).
5. As for side effects, the opinion of pulmonologists is interesting. They report increased cases of severe, difficult-to-control cough while taking ACE inhibitors. As one cardiologist confirmed, every second of his patients coughs in response to the use of Lisinopril or Enalapril.

So, doctors also find it difficult to answer the question of which is stronger - Enalapril or Lisinopril, and which is better.

Which drug is the most effective?

The question of how Lisinopril or Enalapril works, which is better and more effective, worries not only drug users. Doctors compared the medicinal properties of the tablets. A group of patients undergoing treatment for arterial hypertension whose blood pressure readings were 140/90 mmHg. Art. one of the medications was prescribed. In each case, the dosage of drugs and the regimen required for the treatment of a particular patient were used.

During therapy with each drug, patients had a qualitative result - blood pressure was within the normal range. The obtained indicators persisted for a longer time in patients taking Lisinopril, that is, this medicine is more effective, as shown by a comparison of therapeutic effects.

It is worth remembering that high blood pressure is a sign of many dangerous pathologies. Prescribing any remedy on your own, even if it has only positive reviews, is very dangerous; it can lead not only to deterioration of health, but also to the death of a person.

You can learn more about the action of ACE inhibitors from the video, where the doctor answers popular questions from patients taking drugs from this group:

An interesting video that helps you understand the wide selection of medications for hypertension, their action and pharmacological properties is presented below:

Are there any differences in contraindications and side effects?

Let's try to find out how the drugs performed in terms of side effects and contraindications. Lisinopril or Enalapril - which is better to take to protect yourself from unwanted manifestations?

Contraindications

The list of contraindications is not what distinguishes Lisinopril from Enalapril. It includes:

• tendency to angioedema;
• the presence of renal artery stenosis;
• the presence of concomitant pathologies - porphyria, hyperkalemia, renal dysfunction;
• the period of bearing a child and breastfeeding;
• age under 18 years;
• individual sensitivity to the composition of the drug.

If some factors are not indicated as contraindications to one of the drugs, then they are present in the list of conditions when it is better to take another drug with caution.

Side effects

The most common side effects, characteristic of both Lisinopril and Enalapril:

• the appearance of a dry hacking cough;
• a sharp drop in blood pressure;
• causeless fatigue, dyspeptic disorders, headaches;
• pain in the chest;
• loss of taste;
• blood pathologies.

However, Enalapril, which is a prodrug and is metabolized in the liver, also has a side effect such as hepatotoxicity (that is, a harmful effect on the liver). And taking Lisinopril creates some stress on the kidneys. Therefore, it is difficult to give preference to this indicator and answer the question Lisinopril or Enalapril - which is better. When selecting a drug, the presence of concomitant pathologies in the patient should be taken into account. If you have impaired liver function, do not use Enalapril, and if you have kidney failure, do not use Lisinopril.

Characteristics of Lisinopril

Lisinopril is a second generation ACE inhibitor. It gently reduces blood pressure for 24 hours after a single dose. It does not tend to accumulate in adipose tissue, so it is highly effective in treating hypertension in obese people. The drug is well tolerated and has a high safety index.

The composition includes the active ingredient - lisinopril dihydrate. Available in tablets of 5, 10 and 20 mg.

The mechanism of action of the drug is based on the suppression of the enzyme that converts the hormone angiotensin I into angiotensin II, which causes vasospasm and increases blood pressure. When its concentration in the blood decreases, peripheral vessels, mainly arteries, expand. Due to this, the drug has a pronounced hypotensive effect. In addition, with long-term use, blood supply to the myocardium improves and left ventricular hypertrophy decreases.

Indications for use:

• arterial hypertension - can be used alone or in combination with other antihypertensive drugs;
• chronic heart failure - in combination with diuretics and cardiac glycosides;
• complex treatment of myocardial infarction in the early stages;
• diabetic nephropathy.

Absolute contraindications:

• sensitivity to Lisinopril or other ACE inhibitor;
• edema of any etiology;
• pregnancy (at all stages) and breastfeeding;
• children's age (up to 18 years).

There are also relative contraindications for which the drug is prescribed, but with extreme caution:

• stenosis of the aortic or mitral valves;
• renal dysfunction: renal artery stenosis, failure with creatinine clearance less than 30 ml/min., transplantation, dialysis;
• vascular diseases of the brain;
• cardiac ischemia;
• connective tissue diseases: scleroderma, systemic lupus erythematosus;
• diabetes;
• state of dehydration and blood loss.

Side effects after taking Lisinopril may include:

• dizziness, headache, general weakness, loss of consciousness,
• dry cough;
• from the cardiovascular system - hypotension, increased or decreased heart rate, chest pain;
• from the nervous system - mood instability, drowsiness;
• from the gastrointestinal tract - loss of appetite, dry mouth, nausea, vomiting, dyspepsia, abdominal pain;
• on the skin - allergic reactions, rashes, itching, baldness, increased sweating;
• in the blood - decreased hemoglobin, leukopenia, thrombocytopenia.

Side effects after taking Lisinopril may include: dizziness, headache, general weakness, loss of consciousness.