Lisinopril

How it works

It inhibits ACE, reducing conversion of angiotensin I to the vasoconstrictor angiotensin II and decreasing aldosterone secretion, which lowers vascular resistance and reduces sodium and water retention.

Prescribing in practice

• It is contraindicated in pregnancy and in anyone with a history of ACE-inhibitor-associated angioedema, which can be life-threatening if it affects the airway.
• First-dose hypotension can occur, especially in volume-depleted patients or those on high-dose diuretics, so initiation should be cautious in these groups.
• It can cause hyperkalaemia and a persistent dry cough, the latter being a common reason for switching to an ARB.

Monitoring

Check renal function and serum potassium before starting and after initiation or dose increase, and monitor blood pressure for response.

Counselling the patient

• Stop the medicine and seek urgent help if your lips, tongue, face or throat swell.
• A persistent dry cough is a known side effect; tell your doctor if it is troublesome.
• Do not take this medicine if you are or could become pregnant.

Evidence & guidelines

ACE inhibitors such as lisinopril are recommended first-line in NICE guidance for hypertension in younger or diabetic patients and for heart failure with reduced ejection fraction, with mortality benefit shown across major heart-failure and post-infarction trials.