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

Most common
Upper respiratory infection (up to 8%)
Dizziness (up to 3%)
Nasal congestion (up to 2%)
Back pain (up to 2%)

Ramipril

Most common
Hypotension (up to 11%)
Cough (up to 8%)
Dizziness (up to 4%)
Angina pectoris (up to 3%)

Losartan vs. Ramipril Dosage

Losartan

Dosage
Dosage Table
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

Dosage
Dosage Table
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

Common Symptoms and Related Diseases You Can Explore

Explore a range of common symptoms the Doctronic Symptom Checker can help you understand.