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How exactly does lisinopril lower blood pressure?

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Here’s everything you should know about this hypertension medication — including who should take it and how to handle side effects.
Written by Kim Robinson
Updated on May 9, 2022

If you have high blood pressure, there’s a good chance you take the medication lisinopril (Zestril®, Prinivil®). This prescription medication has been used for more than 30 years to lower blood pressure.

Lisinopril is part of a family of blood pressure medications called angiotensin converting enzyme (ACE) inhibitors. ACE inhibitors are usually the first medication that doctors prescribe to manage high blood pressure.

“Anyone who is diagnosed with high blood pressure, heart failure or has recently had a heart attack is recommended to be on medication in lisinopril’s family,” says K. Ashley Garling, PharmD. She’s a clinical assistant professor at the University of Texas at Austin College of Pharmacy’s Pharmacy Practice division.

Lisinopril is a popular ACE inhibitor because it’s usually the cheapest and most available, she says. (Whatever medication you’re on, we might be able to help you save. Grab our free prescription coupon app to find and share discounts.)

Here’s what you should know about taking lisinopril, including how it works and how to handle potential side effects.

How does lisinopril work?

Think of your blood vessels as a hose. When the pressure in that hose is high, it can cause damage and tears over time. In arteries, those openings create pockets for LDL (or bad) cholesterol to collect, according to the American Heart Association. These collections form plaques that make arteries thick and stiff. And this puts you at risk for heart disease, a heart attack or a stroke.

That’s why treating high blood pressure is so important. When your blood vessels are elastic and open, it makes your heart’s job easier.

Lisinopril works by blocking an enzyme in the body that narrows blood vessels. This helps blood vessels relax and open, which lowers blood pressure and increases the supply of blood and oxygen to the heart.

Lisinopril can also be used to treat heart failure, according to the Mayo Clinic. (This is what heart failure is and the signs to watch for.)

How often do I have to take it?

Most people take lisinopril by mouth daily in either tablet or liquid form. The medication doesn’t cure high blood pressure, but it helps manage the condition. So do lifestyle tweaks such as moving (even a little bit) every day and cutting back on alcohol. Here are 14 more little ways to lower your blood pressure.

For lisinopril, consistency is key. “Taking your daily dose at a regular time each day can help ensure that your blood pressure is steady throughout the day,” says Garling.

To help stay on track, she advises patients to anchor it to another habit. “For example, put your medication bottle next to the coffee pot or next to your water glass on the bedside table.” Just avoid putting it in the bathroom. The humidity from your hot showers can make it not work as well.

What happens if I miss a dose?

Take the missed dose as soon as you remember, says Inna Lukyanovsky, PharmD. She’s a pharmacist based in Manalapan, New Jersey, who specializes in functional medicine.

The exception: if it’s almost time for your next dose. You don’t want to double up on lisinopril. It could drop your blood pressure too low. When in doubt, talk to your doctor about what to do if this happens.

What are the most common side effects?

As with any medication, lisinopril can sometimes cause side effects. Common symptoms include:

  • Dizziness. This can happen often, especially when getting up from sitting or lying down, Garling says. To help avoid dizziness, stay hydrated unless your doctor has told you to restrict fluids. Also take your time when moving from different positions. For example, she recommends kicking your feet as if you’re swimming for a few minutes before you get out of bed or out of a chair.
  • Low blood pressure. Sometimes blood pressure medications can lower your blood pressure too much. (Low blood pressure is generally considered less than 90/60 mm Hg.) Garling recommends tracking your blood pressure a few times a week to keep a good baseline blood pressure. She recommends checking in the morning for consistency. If the top number on your blood pressure meter at rest is equal to or under 100 mm Hg, keep monitoring it throughout the day. If the number stays low or drops even lower, call your doctor or go to the emergency room, she says.
  • Dry cough. In some people, inhibiting ACE enzymes can trigger the cough reflex. “I’ve often heard patients describe it as a tickle in the throat that won’t go away or the feeling of always having to clear your throat,” Garling says. If your cough doesn’t go away, your doctor might have to switch you to a new type of blood pressure medication known as angiotensin receptor blockers (ARBs), she adds. They work very similarly to ACE inhibitors but are less likely to cause a cough.

Other side effects may include headaches, nausea and extreme tiredness. Some doctors will slowly raise the dose of your medication to help avoid side effects. If you do notice any, tell your doctor right away. The provider may be able to adjust your dose or prescribe another medication to ease the discomfort. Find out more about the different types of blood pressure medication.

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When are side effects of lisinopril considered dangerous?

Some side effects of lisinopril can be serious. If you experience any of these symptoms, call your doctor immediately:

  • Swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles or lower legs
  • Hoarseness
  • Difficulty breathing or swallowing
  • Fever, sore throat, chills and other signs of infection
  • Yellowing of the skin or eyes
  • Fainting
  • Chest pain

Some of these symptoms can be signs of rare, but dangerous, outcomes of taking an ACE inhibitor. This includes hyperkalemia, which is having high potassium in the blood. That can cause an irregular heartbeat.

To avoid that happening, ask your doctor before taking in non-food sources of potassium, Garling says. These include vitamins, dietary supplements, dietary drinks (such as Ensure®) and salt substitutes using potassium.

Some people may also experience angioedema, Garling says. “It’s a rare but serious reaction to ACEs like lisinopril. It can cause swelling and buildup of fluid in the lips, tongue, intestines and other areas.”

Who can take lisinopril?

Lisinopril is approved for people age 6 and up with high blood pressure. People who have heart failure and long-term kidney conditions can take it as well, says Lukyanovsky. Some people, though, should not take lisinopril, she says, including those who:

  • Are pregnant or breastfeeding
  • Have severe kidney failure
  • Have allergic reactions to ACE inhibitors
  • Have a history of angioedema

Research also shows that lisinopril and other ACE inhibitors may not work as well for Black patients with high blood pressure unless they’re paired with medications such as a calcium channel blocker or a diuretic.

No matter how you manage your blood pressure, we want to help you save on your prescription medication. Simply show this free discount card to your pharmacist — you could save up to 80%.

Additional sources
Lisinopril for heart failure: Mayo Clinic
Health threats from high blood pressure: American Heart Association