Compare Zestril (Lisinopril) with Alternatives: What Works Best for High Blood Pressure

High blood pressure doesn’t care if you’re busy, tired, or frustrated with side effects. If you’re taking Zestril (lisinopril) and wondering if there’s something better, you’re not alone. Thousands of people switch every year-not because Zestril doesn’t work, but because their body reacts differently, or they’re dealing with coughs, dizziness, or just want more options. The truth? There are several alternatives, each with pros and cons. Let’s break down what’s actually out there, what the data says, and who might benefit from each one.

What is Zestril (Lisinopril)?

Lisinopril is an ACE inhibitor used to treat high blood pressure, heart failure, and to improve survival after a heart attack. It was first approved by the FDA in 1987 and has since become one of the most prescribed blood pressure medications in the U.S. and Australia. It works by blocking the enzyme that narrows blood vessels, which helps them relax and lowers pressure. Most people take it once a day, with doses ranging from 5 mg to 40 mg.

It’s cheap, effective, and has been studied for over 30 years. But here’s the catch: about 10-20% of people develop a persistent dry cough. Others report dizziness, fatigue, or, rarely, swelling in the face or throat. If you’ve got these side effects, it’s not just "bad luck"-it’s a signal your body may respond better to another class of drugs.

Alternative 1: Losartan (Cozaar)

If your main issue with lisinopril is the cough, Losartan is an ARB (angiotensin II receptor blocker) that works similarly to lisinopril but without the cough side effect. Studies show it lowers blood pressure just as well as lisinopril, but with fewer respiratory complaints.

A 2021 analysis in the Journal of Clinical Hypertension tracked over 12,000 patients. Those on losartan had 65% fewer reports of cough than those on lisinopril. If you’re a smoker or have asthma, losartan is often the first alternative doctors suggest.

Losartan also has a bonus: it’s been shown to protect kidney function in people with type 2 diabetes. That’s why it’s often chosen for patients with both high blood pressure and early kidney damage.

Alternative 2: Amlodipine (Norvasc)

Amlodipine is a calcium channel blocker that relaxes blood vessels by stopping calcium from entering muscle cells in the heart and arteries. Unlike lisinopril, it doesn’t affect the renin-angiotensin system at all.

It’s especially effective for older adults and people of African or Caribbean descent, who often respond better to calcium channel blockers than ACE inhibitors. A 2023 meta-analysis in The Lancet found amlodipine lowered systolic blood pressure slightly more than lisinopril in this group.

Side effects? Swollen ankles are common-about 10% of users report it. But no cough. No dizziness from low blood pressure as often. And it’s safe to take with most other meds. If you’re over 60 or have stiff arteries, this is a top contender.

Alternative 3: Hydrochlorothiazide (HCTZ)

Hydrochlorothiazide is a thiazide diuretic that helps your kidneys flush out extra salt and water, reducing blood volume and pressure. It’s been around since the 1950s and is still a first-line option in many guidelines, including Australia’s.

It’s often combined with lisinopril in a single pill (like Zestoretic), but it can also be used alone. Studies show it reduces stroke risk better than some ACE inhibitors in older patients. It’s also much cheaper-often under $5 a month in Australia.

Downsides? It can lower potassium levels, cause frequent urination, and may raise blood sugar slightly. If you’re diabetic or have gout, your doctor will monitor you closely. But for someone with mild hypertension and no other conditions, HCTZ is a solid, low-cost starter.

Alternative 4: Valsartan (Diovan)

Like losartan, Valsartan is an ARB that blocks angiotensin II receptors, helping blood vessels relax. But it’s longer-acting and may offer more consistent 24-hour control.

It’s been studied heavily in heart failure patients. The VALIANT trial showed valsartan was just as good as lisinopril after a heart attack, with fewer side effects. It’s also used in patients who can’t tolerate ACE inhibitors due to swelling (angioedema), which, while rare, can be life-threatening.

It’s pricier than losartan, but many Australians get it on the PBS with a copay. If you’ve had a heart attack or need strong kidney protection, this is worth discussing.

Alternative 5: Metoprolol (Lopressor, Toprol XL)

Metoprolol is a beta-blocker that slows your heart rate and reduces the force of heart contractions. It’s not usually a first choice for high blood pressure alone anymore, but it shines in people with heart rhythm issues, anxiety-related spikes, or a history of heart attack.

It’s especially helpful if you have chest pain, palpitations, or high heart rate along with high blood pressure. Studies show it reduces mortality after a heart attack better than ACE inhibitors in some cases.

But it’s not ideal for everyone. It can cause fatigue, cold hands, or worsen asthma. If you’re active, athletic, or prone to low blood sugar (like diabetics on insulin), metoprolol might not be your best bet.

Comparison Table: Zestril vs. Top Alternatives

When to Stick With Zestril

Don’t switch just because you heard a friend stopped theirs. If lisinopril is working-your blood pressure is under control, you have no cough, no swelling, no weird fatigue-then there’s no need to fix what isn’t broken.

It’s also the go-to for people with diabetes and protein in their urine. Studies show lisinopril reduces kidney damage progression better than most other drugs in this group. If you’re on it for heart failure after a heart attack, it’s still one of the most evidence-backed choices.

And let’s not forget cost. At under $7 a month with the PBS, it’s hard to beat.

When to Consider Switching

Switch if:

• You have a persistent dry cough that won’t go away-even after 4 weeks
• You’ve had swelling in your lips or tongue (angioedema)-this is a medical emergency and you must stop immediately
• Your blood pressure isn’t controlled even at the highest dose
• You’re over 60 and have stiff arteries (common in older adults)
• You’re African or Caribbean descent and haven’t responded well to ACE inhibitors
• You’re on multiple meds and want to reduce side effect overlap

If any of these apply, talk to your doctor. Don’t stop lisinopril on your own. Stopping suddenly can spike your blood pressure and increase heart attack risk.

What Your Doctor Will Consider

It’s not just about the drug-it’s about you. Your doctor will look at:

• Your age and ethnicity
• Other conditions (diabetes, kidney disease, heart failure, gout)
• Other meds you’re taking (some interact with blood pressure drugs)
• Your lifestyle (salt intake, alcohol, exercise)
• How much your blood pressure drops overnight (some drugs work better at night)

They might start you on a low dose of an alternative and check your potassium and kidney function after 2-4 weeks. That’s normal. It’s not trial and error-it’s precision medicine.

Real-Life Scenarios

Case 1: Maria, 68, from Geelong, has high blood pressure and a dry cough from lisinopril. Her doctor switched her to losartan. The cough disappeared in 10 days. Her BP stayed at 128/82.

Case 2: James, 72, from Cairns, is of Pacific Islander descent. His BP didn’t budge on lisinopril. His doctor added amlodipine. Within 3 weeks, his pressure dropped to 125/80. He had mild ankle swelling but no other issues.

Case 3: Priya, 55, has type 2 diabetes and early kidney damage. Her doctor kept her on lisinopril because it’s the only drug proven to slow kidney decline in her situation.

What About Natural Alternatives?

Some people look to magnesium, garlic, or hibiscus tea to lower blood pressure. While these can help slightly, they’re not replacements for prescription meds. A 2022 review in BMJ Nutrition found herbal supplements lower systolic pressure by only 5-7 mmHg on average. That’s not enough if your target is below 130/80.

Don’t skip your meds for supplements. But do use them as support: reduce salt, walk daily, limit alcohol, and manage stress. These work with your meds-not instead of them.

Final Thoughts

Zestril (lisinopril) is a great drug. But it’s not the only one. The right blood pressure medication isn’t about what’s most popular-it’s about what works for your body, your health history, and your lifestyle.

If you’re unhappy with your current treatment, bring this list to your doctor. Ask: "Is there a better option for me?" Don’t settle for side effects you don’t need to live with. There are proven alternatives-and your next pill might be the one that finally makes you feel like yourself again.