Lisinopril is a long-acting ACE inhibitor used in hypertension, heart failure, and post–myocardial infarction care.

It is one of the most commonly prescribed ACE inhibitors.

Class: → ACE Inhibitors

• Inhibits Angiotensin-Converting Enzyme (ACE) • ↓ Angiotensin II • ↓ Aldosterone • ↑ Bradykinin

Net Effects: • ↓ Systemic vascular resistance (afterload) • Mild ↓ preload • ↓ Ventricular remodeling • ↓ Blood pressure

• First-line agent in many patients • Especially beneficial in diabetes or CKD

→ Hypertension Module

• Mortality reduction • Reduced hospitalization • Prevents ventricular remodeling

Core GDMT component.

→ Heart Failure Module

• Reduces remodeling • Improves survival

• ↓ Proteinuria • Slows CKD progression

Hypertension: • Start: 5–10 mg daily • Usual range: 10–40 mg daily • Max: 40 mg daily

Heart Failure: • Start low (2.5–5 mg daily) • Titrate to 20–40 mg daily as tolerated

Once-daily dosing.

• Not a prodrug • Not hepatically metabolized • Renally cleared • Half-life ~12 hours

Dose adjustment required in renal impairment.

• Dry cough • Hyperkalemia • Hypotension • Angioedema (rare) • Mild creatinine elevation

Check: • Serum creatinine • Potassium

Recheck labs 1–2 weeks after initiation or dose change.

Mild creatinine rise (<30%) is expected.

• Pregnancy • History of ACE inhibitor–induced angioedema • Bilateral renal artery stenosis

Increased hyperkalemia risk with: • Spironolactone • Eplerenone • Potassium supplements • ARBs

Avoid dual ACE + ARB therapy.

✔ One of the most commonly used ACE inhibitors ✔ Once-daily dosing ✔ Mortality benefit in HFrEF ✔ Monitor potassium and creatinine ✔ Switch to ARB if cough develops

Related:

→ ACE Inhibitors → ARBs → ARNI → Return to CV Modules