One of the most commonly prescribed medications in the United States is lisinopril, a blood pressure medication that’s been around for nearly three decades. Lisinopril relaxes the blood vessels and lower blood pressure by blocking the production of a hormone called angiotensin II. But as it turns out, lisinopril has many additional upsides for you.
Here are eight really cool things about lisinopril outside of treating high blood pressure:
- 1) Protecting heart attack patients
- 2) Improving symptoms of heart failure
- 3) Improving mitral valve regurgitation
- 4) Preventing diabetes
- 5) Protecting the kidneys in people with diabetes
- 6) Slowing eye disease in people with diabetes
- 7) Improving fertility in men
- 8) Preventing migraines
- High Blood Pressure Drug Lisinopril Lowers Risk Of Heart Block
- How Your Heart’s Electrical System Works
- What Is Electrical Heart Block?
- Risk Factors for Electrical Heart Block
- How High Blood Pressure Treatment Can Help
- Research: ACE Inhibitors Lower Risk of Heart Block
- Prescription blood pressure drugs come in many classes
- Overviews of the classes of blood pressure medications
- The classes of blood pressure medications include:
1) Protecting heart attack patients
Lisinopril, used after a heart attack, has beneficial effects on survival. An analysis of 100,000 patients showed that folks who started taking an ACE (angiotensin-converting-enzyme) inhibitor drug like lisinopril within 36 hours of heart attack had a lower risk of death after 30 days than those who did not.
2) Improving symptoms of heart failure
Symptoms of heart failure include shortness of breath, lower extremity edema (swelling from fluid buildup), and decreased exercise tolerance or chest pain. Lisinopril may improve these symptoms as well as lower the risk of death.
3) Improving mitral valve regurgitation
Mitral valve regurgitation, a condition where the heart’s mitral valve doesn’t close properly, allows blood to flow backwards in the heart and causes shortness of breath and lightheadedness. In one study, mitral valve regurgitation was shown to improve after one year in people who took lisinopril.
4) Preventing diabetes
In a five-year study, people who took lisinopril had a significantly lower risk of developing diabetes compared to people to took chlorthalidone. Lisinopril and chlorthalidone are both medications used to treat high blood pressure. Chlorthalidone, however, is a diuretic, which means it lowers blood pressure by increasing the amount of fluids the body excretes.
5) Protecting the kidneys in people with diabetes
In people with diabetes, lisinopril helps prevent kidney disease from progressing and reduces the amount of protein that goes unfiltered by the kidneys and ends up in urine (a.k.a. proteinuria). An ACE inhibitor like lisinopril is recommended as first-line treatment for high blood pressure in people with diabetes and in people with microalbumin (small proteins) in their urine.
6) Slowing eye disease in people with diabetes
In a study of people with diabetes, taking lisinopril slowed the rate of eye disease progression—specifically, diabetic retinopathy—by half compared to not taking it.
7) Improving fertility in men
In a study on men with low sperm count, semen returned to normal in half of the men who took lisinopril, which means total sperm count and the percentage of motile sperm increased.
8) Preventing migraines
In a study on patients with migraine, those taking lisinopril (compared to taking nothing) experienced 20% fewer hours of headaches and 21% fewer days with a migraine. The severity of their headaches was also reduced by 20%.
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What is this medication?
The official name for these drugs is angiotensin-converting enzyme inhibitors. But they are usually called ACE inhibitors.
- Generic names are listed first.
- Canadian brand names are in brackets.
- This list doesn’t include every brand name.
- If your prescription isn’t listed, your pharmacist is the best source for more information.
What does it do?
ACE inhibitors reduce the risk of having a heart attack.
- They open the blood vessels and make it easier for your heart to do its job.
- If your heart has been weakened, an ACE inhibitor will protect it and help it get stronger.
Key facts about ACE inhibitors:
- Make it easier for your heart to pump.
- Lower blood pressure.
- Protect the heart and blood vessels.
- Protect the kidneys in people with diabetes or kidney disease.
- Are usually taken for life if you have coronary artery disease.
How do I take it?
Take your ACE inhibitor exactly as prescribed.
Try to take it at the same time(s) every day.
- If you take it more than once each day, space it out through the day.
- If you miss a dose, take it as soon as you remember. Do this unless it’s almost time for the next dose.
- Never double-up your dose or take extra medication to make up for the missed dose.
When you start on an ACE inhibitor, you will need blood tests to monitor your kidney function and potassium levels.
Be aware: If you take an ACE inhibitor, keep a written log of your heart rate (pulse) and blood pressure.
- Track your heart rate by taking your pulse daily.
- Write down your blood pressure numbers every time you take your blood pressure. It could be from your healthcare provider, the automated blood pressure machine at the drugstore, or your home blood pressure monitor.
Are there any interactions?
Some medications can stop your heart medicine from working properly. They may even cause other health problems.
- ACE inhibitors can increase the amount of potassium in your body.
- Avoid salt substitutes or potassium supplements unless they are prescribed for you.
- You may be prescribed an ACE inhibitor or an ARB (angiotensin receptor blocker), but probably not both.
- It may be harmful to take both types of medication together, unless specifically directed.
Tell your healthcare provider and pharmacist about all the medications you are taking. These include:
- Non-prescription drugs
- Creams or ointments
- Over-the-counter or natural health products
- Alternative therapies
- Vitamins, minerals or supplements
- Herbal remedies
- Homeopathic medicines
- Traditional remedies, such as Chinese medicines
Are there any side effects?
ACE inhibitors can cause some side effects.
- ACE inhibitors will lower your blood pressure.
- If you are dizzy or feel like you might faint, sit or lie down right away.
- Get up slowly to give your blood vessels time to adjust.
- If you take your ACE inhibitor once per day, try taking it at bedtime to ease dizziness.
- Don’t drink alcohol if you have dizziness or if your medication makes you sleepy.
- You may develop a dry cough or tickle in the throat that does not go away.
If you have side effects, talk to your pharmacist or healthcare provider.
Be aware: You may develop swelling of the face, mouth, or throat, or notice that you are peeing less than normal.
Call your healthcare provider right away or go to the closest emergency room if this happens to you.
Lifestyle changes that can also help
There are two ways to control and manage your heart health: medication and lifestyle.
Medication can help you control heart disease and high blood pressure, but it cannot cure it.
A healthy lifestyle can help you keep medication to a minimum.
Visit heartandstroke.ca/get-healthy. Learn how to keep your heart healthy with current information and advice from Heart and Stroke Foundation experts.
Talk to your healthcare provider about the most beneficial lifestyle goals for you.
Your healthcare provider or pharmacist are your best sources of information. You can also learn more about medications at any of these trusted sites.
Health Canada – Drugs and Health Products
Provides health and medical information for Canadians to maintain and improve their health.
Learn more about:
- Safe Use of Medicines
- Safety and Effectiveness of Generic Drugs
- Buying drugs over the Internet
- Drug Product Database
- MedEffect Canada
Provides safety alerts, public health advisories, warnings and recalls.
Your ministry of health also offers health resources in your province or territory. For example, Ontario’s MedsCheck program provides free pharmacist consultations. And British Columbia’s Senior Healthcare web page provides information about important health programs.
Québec has the Portail santé mieux-être for my loved ones and me : sante.gouv.qc.ca/EN/: Health and Psychosocial Issues; Advice and Prevention; Assistance measures and Programs; Finding a resource.
High Blood Pressure Drug Lisinopril Lowers Risk Of Heart Block
The average heart beats 100,000 to 120,000 times each day. And since the average person in the United States will live into their mid- to late-seventies, this means your heart will beat over two billion times in your life. To accomplish all of this pumping, your heart develops specialized pacemaker cells and conduction tissues that conveys electrical impulses across your heart.
Despite their critical role, these specialized conductive tissues are delicate. They also age, and in some people they can stop working and cause heart disease. New research shows that a common treatment for high blood pressure (hypertension) may help keep the heart’s electrical system healthy as you get older.
How Your Heart’s Electrical System Works
The electrical impulse of your heart begins in the right upper chamber from a group of specialized pacemaker cells called the sinoatrial (SA) node. The electrical impulse is quickly carried across both upper heart chambers: the atria. When heart muscle cells are stimulated by electricity, they contract, or squeeze. The two upper chambers squeeze in unison and pump blood into the two lower heart chambers: the ventricles.
The electrical signal is collected in the middle of the heart in a relay center called the atrioventricular (AV) node. Then, through long specialized electrical tracts called the right and left bundle branches, the electricity is delivered to the bottom portion of the ventricles, which then squeeze from the bottom up and push the blood out to the great arteries of your body.
What Is Electrical Heart Block?
When most people think about heart blockages, they see images of blocked arteries from cholesterol plaques that can cause a heart attack (myocardial infarction). But a completely separate blockage that involves the heart’s electrical system — a heart block — can develop along all levels of the conduction systems and on multiple levels: in the AV or SA node, or in the bundle branches (parts of the heart’s electrical system that deliver impulses to your ventricles).
If you experience a heart block, you may experience some of the following:
- Chest discomfort
- Shortness of breath
- Exercise intolerance
- Syncope (temporary loss of consciousness, or fainting)
Unfortunately, once disease develops in the heart’s conduction system, it often progresses with no known medical therapies to improve it. If you develop heart block and have symptoms, or if the upper and lower heart chambers of your heart no longer communicate electrically, you may need a surgically implanted pacemaker. This device, which delivers small electrical impulses to your upper and lower heart chambers, replaces any missed beats from the diseased conduction system or from significant delays or blocks in electrical communication.
You may know someone who has a pacemaker. Between 1993 and 2009, about three million U.S. patients received a pacemaker for symptomatic electrical heart block, according to a survey published in the Journal of the American College of Cardiology in October 2012. During the study time, the use of pacemakers increased by 56 percent — a trend that continues today as our society ages, and people live longer with heart disease.
Risk Factors for Electrical Heart Block
Risk factors for heart block include:
- High blood pressure
- Heart valve disease
- Heart infection
- Heart attack
- Heart failure
- Having heart surgery
The most common risks are aging and high blood pressure. And while you can’t do much about aging, you can do something about high blood pressure. Depending on how you treat it, you may lower your risk of conduction system disease.
How High Blood Pressure Treatment Can Help
Doctors treat high blood pressure in many different ways, some of which I’ve covered in previous columns, like being careful not to eat too much salt. In addition to lifestyle changes, multiple blood pressure medications called anti-hypertensive agents can be used to treat the disease and prevent progression and complications.
All blood pressure medications lower your blood pressure, but drugs like beta-blockers and calcium channel blockers also lower heart rate. And some, like diuretics, lower fluid levels in the body and can decrease edema (swelling). Still others, such as ACE inhibitors or angiotensin receptor blockers (ARBs), can impact the body’s inflammatory response and decrease fibrosis or cell breakdown.
Research: ACE Inhibitors Lower Risk of Heart Block
With these unique aspects of blood pressure medications in mind, and knowing that high blood pressure can result in early conduction system disease, researchers asked which medications might lower blood pressure and also decrease risk of conduction system disease.
The Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) included 21,004 patients ages 55 and older who had high blood pressure and one other heart disease risk factor, such as high cholesterol, diabetes, coronary artery disease, or a history of smoking. The patients were either treated with an ACE inhibitor lisinopril; a calcium channel blocker, Norvasc (amlodipine besylate); or a diuretic, Thalitone (chlorthalidone) and a statin drug, Pravachol (pravastatin) for their high cholesterol. ALLHAT results were published in JAMA Internal Medicine in June 2016.
Researchers followed the patients for up to eight years to look for heart disease and found that 1,114 people developed heart block. These included 570 patients with a complete right bundle branch block, and 389 with a complete left bundle branch block.
Being older increased the risk of developing conduction system disease by 47 percent in this group of patients with high blood pressure, and was the strongest predictor that they would develop a heart block.
In this study, statins didn’t lower a person’s risk of conduction system disease. But using the ACE inhibitor lisinopril lowered risk of electrical conduction disease by 19 percent compared to the diuretic, and by 14 percent compared to the calcium channel blocker.
This large study of older adults also confirmed that high blood pressure and age present unique challenges to the heart’s electrical system, and that conduction abnormalities commonly develop. But for the first time, we have insight into a potential way to prevent or significantly lower the risk of conduction system disease in people who have high blood pressure by using a commonly prescribed drug.
Follow Dr. Bunch @TJaredBunch on Twitter. He’s also a frequent guest on The Dr. John Day Show podcast, available on iTunes.
Photo: Dmitry Fisher/Getty Images
Prescription blood pressure drugs come in many classes
Many blood pressure medications, known as antihypertensives, are available by prescription to lower high blood pressure (HBP or hypertension). There are a variety of classes of high blood pressure medications and they include a number of different drugs. In the widget below, you will find an overview of the classes of blood pressure medication. To expand the information on a type of medication, simply click on the subject tab.
Overviews of the classes of blood pressure medications
In the tabs below, you’ll find summaries of some of the major types of commonly prescribed cardiovascular medications.
- For your information and reference, we have included generic names as well as major trade names to help you identify what you may be taking. However, this information does not signify a recommendation or endorsement from the American Heart Association.
- If your prescription medication isn’t on this list, remember that your healthcare provider and pharmacist are your best sources of information.
- It’s important to discuss all of the drugs you take with your doctor and understand their desired effects and possible side effects.
- Never stop taking a medication and never change your dose or frequency without first consulting your doctor.
The classes of blood pressure medications include:
- ACE inhibitors
- Angiotensin II receptor blockers
- Calcium channel blockers
- Alpha blockers
- Alpha-2 Receptor Agonists
- Combined alpha and beta-blockers
- Central agonists
- Peripheral adrenergic inhibitors
Diuretics help the body get rid of excess sodium (salt) and water and help control blood pressure. They are often used in combination with additional prescription therapies.
Generic name Common brand names Thiazide diuretics chlorthalidone Hygroton* chlorothiazide Diuril* hydrochlorothiazide Esidrix*, Hydrodiuril*, Microzide* indapamide Lozol* metolazone Mykrox*, Zaroxolyn* Potassium-sparing diuretics amiloride hydrochloride Midamar* spironolactone Aldactone* triamterene Dyrenium* Loop diuretic furosemide Lasix* bumetanide Bumex* Combination diuretics amiloride hydrochloride + hydrochlorothiazide Moduretic* spironolactone + hydrochlorothiazide Aldactazide* triamterene + hydrochlorothiazide Dyazide*, Maxzide*
Some noted possible side effects from diuretics:
- Some of these drugs may decrease your body’s supply of the mineral potassium. Symptoms such as weakness, leg cramps or being tired may result. Eating foods containing potassium may help prevent significant potassium loss. If your doctor recommends it, you could prevent potassium loss by taking a liquid or tablet that has potassium along with the diuretic. Diuretics such as amiloride (Midamar)*, spironolactone (Aldactone)* or triamterene (Dyrenium)* are called “potassium sparing” agents. They don’t cause the body to lose potassium. They might be prescribed alone, but are usually used with another diuretic. Some of these combinations are Aldactazide*, Dyazide*, Maxzide* or Moduretic*.
- Some people suffer from attacks of gout after prolonged treatment with diuretics. This side effect isn’t common and can be managed by other treatment.
- People with diabetes may find that diuretic drugs increase their blood sugar level. A change in medication, diet, insulin or oral anti-diabetic dosage corrects this in most cases.
- Impotence may occur.
Beta-blockers reduce the heart rate, the heart’s workload and the heart’s output of blood, which lowers blood pressure.
Generic name Common brand names acebutolol Sectral* atenolol Tenormin* betaxolol Kerlone* bisoprolol fumarate Zebeta* carteolol hydrochloride Cartrol* metoprolol tartrate Lopressor* metoprolol succinate Toprol-XL* nadolol Corgard* penbutolol sulfate Levatol* pindolol* Visken* propranolol hydrochloride* Inderal* solotol hydrochloride Betapace* timolol maleate* Blocadren* Combination beta-blocker/diuretic hydrochlorothiazide and bisoprolol Ziac*
Some noted possible side effects of beta-blockers:
- Cold hands and feet
- Tiredness or depression
- Slow heartbeat
- Symptoms of asthma
- Impotence may also occur
- If you have diabetes and you’re taking insulin, have your responses to therapy monitored closely.
- If you have been prescribed beta-blockers, consult your healthcare provider prior to conception if you are considering pregnancy or if there is a chance you could become pregnant. If you discover that you are pregnant consult your healthcare provider as soon as possible to determine the safest medication for you at this time.
Angiotensin is a chemical that causes the arteries to become narrow, especially in the kidneys but also throughout the body. ACE stands for Angiotensin-converting enzyme. ACE inhibitors help the body produce less angiotensin, which helps the blood vessels relax and open up, which, in turn, lowers blood pressure.
Generic name Common brand names benazepril hydrochloride Lotensin* captopril Capoten* enalapril maleate Vasotec* fosinopril sodium Monopril* lisinopril Prinivel*, Zestril* moexipril Univasc* perindopril Aceon* quinapril hydrochloride Accupril* ramipril Altace* trandolapril Mavik*
Some noted possible side effects of ACE inhibitors:
- Skin rash
- Loss of taste
- Chronic dry, hacking cough
- In rare instances, kidney damage
- Women who are taking ACE inhibitors or ARBs for high blood pressure should not become pregnant while on this class of drugs. If you’re taking an ACE inhibitor or an ARB and think you might be pregnant, see your doctor immediately. These drugs have been shown to be dangerous to both mother and baby during pregnancy. They can cause low blood pressure, severe kidney failure, excess potassium (hyperkalemia) and even death of the newborn.
Angiotensin II receptor blockers
These drugs block the effects of angiotensin, a chemical that causes the arteries to become narrow. Angiotensin needs a receptor- like a chemical “slot” to fit into or bind with- in order to constrict the blood vessel. ARBs block the receptors so the angiotensin fails to constrict the blood vessel. This means blood vessels stay open and blood pressure is reduced.
Generic name Common brand names candesartan Atacand* eprosartan mesylate Teveten* irbesarten Avapro* losartan potassium Cozaar* telmisartan Micardis* valsartan Diovan*
Some noted possible side effects of Angiotensin II receptor blockers:
- May cause occasional dizziness.
- ARBs should not be used during pregnancy. Medications that act directly on the renin-angiotensin system can cause injury or even death to a developing fetus. When pregnancy is detected, consult your healthcare professional as soon as possible.
Calcium channel blockers
This drug prevents calcium from entering the smooth muscle cells of the heart and arteries. When calcium enters these cells, it causes a stronger and harder contraction, so by decreasing the calcium, the hearts’ contraction is not as forceful. Calcium channel blockers relax and open up narrowed blood vessels, reduce heart rate and lower blood pressure.
Generic name Common brand names amlodipine besylate Norvasc*, Lotrel* bepridil Vasocor* diltiazem hydrochloride Cardizem CD*, Cardizem SR*, Dilacor XR*, Tiazac* felodipine Plendil* isradipine DynaCirc*, DynaCirc CR* nicardipine Cardene SR* nifedipine Adalat CC*, Procardia XL* nisoldipine Sular* verapamil hydrochloride Calan SR*, Covera HS*, Isoptin SR*, Verelan*
Some noted possible side effects of calcium channel blockers:
- Swollen ankles
These drugs reduce the arteries’ resistance, relaxing the muscle tone of the vascular walls.
Generic name Common brand names doxazosin mesylate Cardura* prazosin hydrochloride Minipress* terazosin hydrochloride Hytrin*
Some noted possible side effects of alpha blockers:
- Fast heart rate
- A drop in blood pressure when you stand up
Alpha-2 Receptor Agonists
These drugs reduce blood pressure by decreasing the activity of the sympathetic (adrenaline-producing) portion of the involuntary nervous system. Methyldopa is considered a first line antihypertensive during pregnancy because adverse effects are infrequent for the pregnant woman or the developing fetus.
Generic name Common brand names methyldopa
Some noted possible side effects of Alpha-2 Receptor Agonists:
- Methyldopa can cause drowsiness or dizziness
Combined alpha and beta-blockers
Combined alpha and beta-blockers are used as an IV drip for those patients experiencing a hypertensive crisis. They may be prescribed for outpatient high blood pressure use if the patient is at risk for heart failure.
Generic name Common brand names carvedilol Coreg* labetalol hydrochloride Normodyne*, Trandate*
A noted possible side effect of combined alpha and beta-blockers:
- May cause a drop in blood pressure when you stand up
Central agonists also help decrease the blood vessels’ ability to tense up or contract. The central agonists follow a different nerve pathway than the alpha and beta-blockers, but accomplish the same goal of blood pressure reduction.
Generic name Common brand names alpha methyldopa Aldomet* clonidine hydrochloride Catapres* guanabenz acetate Wytensin* guanfacine hydrochloride Tenex*
Some noted possible side effects of central agonists:
- Alpha methyldopa (Aldomet)* may produce a greater drop in blood pressure when you’re in an upright position (standing or walking), and it may make you feel weak or faint if the pressure has been lowered too far. This drug may also cause drowsiness or sluggishness, dryness of the mouth, fever or anemia. Male patients may experience impotence. If this side effect persists, your doctor may have to change the drug dosage or use another medication.
- Clonidine (Catapres)*, guanabenz (Wytensin)* or guanfacine (Tenex)* may produce severe dryness of the mouth, constipation or drowsiness. If you’re taking any of these drugs, don’t stop suddenly because your blood pressure may rise quickly to dangerously high levels.
Peripheral adrenergic inhibitors
These medications reduce blood pressure by blocking neurotransmitters in the brain. This blocks the smooth muscles from getting the “message” to constrict. These drugs are rarely used unless other medications don’t help.
Generic name Common brand names guanadrel Hylorel* guanethidine monosulfate Ismelin* reserpine Serpasil*
Some noted possible side effects of peripheral adrenergic inhibitors:
- Reserpine may cause a stuffy nose, diarrhea or heartburn. These effects aren’t severe, and no treatment is required other than to change the dosage. If you have nightmares or insomnia or get depressed, tell your doctor immediately.
- Guanadrel (Hylorel)* or guanethidine (Ismelin)* may cause some diarrhea, which may persist in some people. This side effect usually becomes less of a problem if you continue treatment. These drugs reduce blood pressure more when you stand. Consequently, you may get dizzy and lightheaded and feel weak when you get out of bed in the morning or stand up suddenly. If you notice any of these reactions and if they persist for more than a minute or two, contact your doctor. He/she may instruct you to reduce or omit the next dose of the medication.
- When taking guanethidine, don’t stand in the hot sun or at a social gathering if you begin to feel faint or weak. These activities cause low blood pressure and fainting. Male patients may experience impotence. Contact your doctor if either of these side effects occurs.
Blood vessel dilators (vasodilators)
Blood vessel dilators, or vasodilators, can cause the muscle in the walls of the blood vessels (especially the arterioles) to relax, allowing the vessel to dilate (widen). This allows blood to flow through better.
Generic name Common brand names hydralazine hydrochloride Apresoline* minoxidil Loniten*†
Some noted possible side effects of vasodilators:
- Hydralazine (Apresoline)* may cause headaches, swelling around the eyes, heart palpitations or aches and pains in the joints. Usually none of these symptoms are severe, and most will go away after a few weeks of treatment. This drug isn’t usually used by itself.
- Minoxidil (Loniten)* is a potent drug that’s usually used only in resistant cases of severe high blood pressure. It may cause fluid retention (marked weight gain) or excessive hair growth.
† Used in severe cases or when kidney failure is present.