Losartan vs. Ramipril
See how Losartan and Ramipril compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Losartan is an ARB and ramipril is an ACE inhibitor, but both lower blood pressure by blocking the renin-angiotensin system and are taken once daily.
Ramipril carries an FDA indication for reducing heart attack, stroke, and cardiovascular death in high-risk patients that losartan does not have.
Losartan carries a much lower risk of the dry, persistent cough that leads many people to stop taking ACE inhibitors like ramipril.
Losartan vs. Ramipril Drug Summary
Losartan
Losartan is an angiotensin II receptor blocker (ARB) used to treat high blood pressure, lower stroke risk in people with an enlarged heart, and slow kidney damage in some people with type 2 diabetes. It comes as a tablet, usually started at 50 mg once daily.
Ramipril
Ramipril is an ACE inhibitor used to treat high blood pressure, lower the risk of heart attack, stroke, and cardiovascular death in high-risk patients, and manage heart failure after a heart attack. It comes as a capsule, usually started at 2.5 mg once daily.
Losartan vs. Ramipril Side Effects
Losartan
Ramipril
Losartan vs. Ramipril Dosage
Losartan
Ramipril
| STAGE | DOSE | WHEN |
| Starting dose | 25 mg once daily | At the start |
| Maximum dose | 100 mg once daily | If needed |
| Dose changes | 2 increases | As tolerated |
| STAGE | DOSE | WHEN |
| Starting dose | 2.5 mg once daily | At the start |
| Maximum dose | 20 mg once daily | If needed |
| Dose changes | 3 increases | As tolerated |
Losartan
| STAGE | DOSE | WHEN |
| Starting dose | 25 mg once daily | At the start |
| Maximum dose | 100 mg once daily | If needed |
| Dose changes | 2 increases | As tolerated |
Ramipril
| STAGE | DOSE | WHEN |
| Starting dose | 2.5 mg once daily | At the start |
| Maximum dose | 20 mg once daily | If needed |
| Dose changes | 3 increases | As tolerated |
Losartan vs. Ramipril Indications
Losartan
Losartan is FDA-approved to treat high blood pressure and to lower the risk of stroke in people with hypertension and an enlarged heart. It is also approved to slow kidney disease in people with type 2 diabetes, high blood pressure, and protein in the urine.
High blood pressure (hypertension)
Stroke risk reduction with left ventricular hypertrophy
Diabetic nephropathy in type 2 diabetes
Often combined with other blood pressure medicines
Ramipril
Ramipril is FDA-approved to treat high blood pressure, alone or with a thiazide diuretic. It is also approved to lower the risk of heart attack, stroke, and cardiovascular death in people 55 and older at high risk, and to treat heart failure after a heart attack.
High blood pressure (hypertension)
Heart attack, stroke, and CV death risk reduction
Heart failure after a heart attack
Often combined with a thiazide diuretic
Losartan vs. Ramipril Pros and Cons
Losartan
Losartan works through a different mechanism than ACE inhibitors, which spares most patients the chronic dry cough that limits ramipril use. Both drugs are inexpensive, widely covered generics, so cost is not usually a deciding factor between them.
Pros
Much lower risk of chronic dry cough than ACE inhibitors
Lower risk of ACE-inhibitor-related angioedema
FDA-approved specifically to slow diabetic kidney disease
Cons
No FDA indication for reducing heart attack or CV death risk
No approved use for heart failure after a heart attack
Fewer decades of outcomes data than older ACE inhibitors
Ramipril
Ramipril has decades of outcomes data behind it, including a large trial showing fewer heart attacks, strokes, and cardiovascular deaths in high-risk patients. That added benefit comes with a higher chance of a persistent dry cough than ARBs like losartan.
Pros
Proven to cut heart attack, stroke, and CV death risk
Also approved for heart failure after a heart attack
Long track record in high-risk cardiovascular patients
Cons
Dry, persistent cough is a common reason for stopping it
Higher relative risk of ACE-inhibitor-related angioedema
No specific diabetic kidney disease indication
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