Lisinopril vs. Hydrochlorothiazide

See how Lisinopril and Hydrochlorothiazide compare on approved uses, dosing, side effects, and cost.

Key Takeaways

  • Lisinopril is an ACE inhibitor that lowers blood pressure and protects the heart and kidneys, while hydrochlorothiazide is a diuretic that removes excess fluid and sodium.

  • Doctors often prescribe both drugs together, since combining an ACE inhibitor with a low-dose thiazide diuretic controls blood pressure better than either drug alone.

  • Lisinopril's main downside is a dry cough, while hydrochlorothiazide's main downside is electrolyte imbalances that need periodic blood test monitoring.

Lisinopril vs. Hydrochlorothiazide Drug Summary

Lisinopril

Lisinopril is an ACE inhibitor that relaxes blood vessels to lower blood pressure and ease the heart's workload. It's approved for hypertension in adults and children 6 and older, heart failure, and improving survival after a heart attack. It's taken as a once-daily tablet, usually starting at 10 mg.

Hydrochlorothiazide

Hydrochlorothiazide is a thiazide diuretic that helps the kidneys remove excess salt and water from the body. It's approved for hypertension, alone or combined with other blood pressure drugs, and for fluid buildup from heart failure, liver disease, or kidney problems. It's taken as a once-daily tablet, usually starting at 25 mg.

Lisinopril vs. Hydrochlorothiazide Side Effects

Lisinopril

Most common
Headache (up to 4%)
Dizziness (up to 4%)
Cough (up to 3%)
Fatigue (up to 1%)

Hydrochlorothiazide

Most common
Weakness (not specified)
Hypotension (not specified)
Hypokalemia (not specified)
Hyperglycemia (not specified)

Lisinopril vs. Hydrochlorothiazide Dosage

Lisinopril

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 10 mg once daily At the start
Maximum dose Up to 40 mg once daily If needed
Dose changes 2 increases As tolerated

Hydrochlorothiazide

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 25 mg once daily At the start
Maximum dose 25-100 mg once daily If needed
Dose changes 2 increases As tolerated

Lisinopril vs. Hydrochlorothiazide Indications

Lisinopril

Lisinopril is FDA-approved to treat high blood pressure in adults and children 6 and older. It's also used to treat heart failure and to improve survival after a heart attack. Some doctors prescribe it off-label to help slow kidney damage in diabetes.

  • Treats high blood pressure in adults and children 6+

  • Used alongside other drugs to treat heart failure

  • Given after a heart attack to improve survival

  • Off-label: sometimes used to slow diabetic kidney damage

Hydrochlorothiazide

Hydrochlorothiazide is FDA-approved to treat high blood pressure, often alongside other antihypertensive drugs. It also treats fluid buildup from heart failure, liver disease, kidney disease, or steroid use. Some doctors prescribe it off-label to prevent certain kidney stones.

  • Treats high blood pressure, alone or combined

  • Treats fluid buildup from heart failure or cirrhosis

  • Treats fluid buildup from kidney disease or steroid use

  • Off-label: sometimes used to prevent kidney stones

Lisinopril vs. Hydrochlorothiazide Pros and Cons

Lisinopril

Lisinopril has decades of outcomes data showing it lowers the risk of heart attack, stroke, and death from heart failure, not just blood pressure readings. It carries a boxed pregnancy warning and commonly causes a persistent dry cough that leads some patients to switch drugs.

Pros

  • Also lowers risk of heart attack, stroke, and heart failure death, not just blood pressure

  • FDA-approved for children as young as 6

  • Once-daily dosing with no food restrictions

  • Slows kidney damage in diabetes, an off-label but common use

Cons

  • Dry cough affects a meaningful share of users and can prompt a switch

  • Boxed warning against use during pregnancy

  • Can raise potassium levels, needing blood test monitoring

  • Less effective as monotherapy in Black patients

Hydrochlorothiazide

Hydrochlorothiazide has more than 60 years of safety data and works well as an add-on when one drug alone isn't enough to control blood pressure. It requires periodic blood tests to catch electrolyte shifts and carries a long-term skin cancer risk with cumulative sun exposure.

Pros

  • More than 60 years of safety data as one of the most-used diuretics

  • Also reduces fluid buildup (edema), not just blood pressure

  • Often added to another antihypertensive for extra blood pressure control

  • Available combined with lisinopril in a single daily pill

Cons

  • Needs periodic blood tests to catch low potassium or sodium

  • Long-term use raises risk of non-melanoma skin cancer

  • Can raise blood sugar and uric acid levels

  • Not usable in patients with sulfonamide allergy or anuria

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