Olmesartan vs. Ramipril
See how Olmesartan and Ramipril compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Olmesartan is an ARB taken once daily for hypertension, while ramipril is an ACE inhibitor used for high blood pressure and certain heart conditions.
Ramipril's most common side effect is a dry cough, an ACE inhibitor class effect that olmesartan, an ARB, is far less likely to cause.
Ramipril has extra FDA approvals for heart failure after a heart attack and for lowering cardiovascular risk in high-risk patients, uses olmesartan does not have.
Olmesartan vs. Ramipril Drug Summary
Olmesartan
Olmesartan is an angiotensin II receptor blocker (ARB) used to treat high blood pressure in adults and children 6 and older. It comes as an oral tablet taken once a day, usually starting at 20 mg and increasing to 40 mg if more blood pressure control is needed. It can be used alone or added to other blood pressure medications.
Ramipril
Ramipril is an angiotensin-converting enzyme (ACE) inhibitor used to treat high blood pressure in adults. It is also approved for heart failure after a heart attack and to lower cardiovascular risk in high-risk patients, taken once daily starting at 2.5 mg and increasing as needed up to 20 mg.
Olmesartan vs. Ramipril Side Effects
Olmesartan
Ramipril
Olmesartan vs. Ramipril Dosage
Olmesartan
Ramipril
| STAGE | DOSE | WHEN |
| Starting dose | 10 mg once daily | At the start |
| Maximum dose | 40 mg once daily | Week 3 onward |
| Dose changes | 2 increases | As tolerated |
| STAGE | DOSE | WHEN |
| Starting dose | 2.5 mg once daily | At the start |
| Maximum dose | Up to 20 mg once daily | If needed |
| Dose changes | 3 increases | As tolerated |
Olmesartan
| STAGE | DOSE | WHEN |
| Starting dose | 10 mg once daily | At the start |
| Maximum dose | 40 mg once daily | Week 3 onward |
| Dose changes | 2 increases | As tolerated |
Ramipril
| STAGE | DOSE | WHEN |
| Starting dose | 2.5 mg once daily | At the start |
| Maximum dose | Up to 20 mg once daily | If needed |
| Dose changes | 3 increases | As tolerated |
Olmesartan vs. Ramipril Indications
Olmesartan
Olmesartan is approved to treat high blood pressure in adults and in children 6 years and older. It can be used by itself or combined with other blood pressure medications. It is not recommended as the first treatment tried in patients 75 or older or in those with liver impairment.
Hypertension in adults
Hypertension in children 6 and older
Can be combined with other antihypertensives
Not first-line in patients 75+ or liver disease
Ramipril
Ramipril is approved to treat high blood pressure in adults. It is also approved for people with heart failure after a recent heart attack, and to lower the risk of heart attack, stroke, or cardiovascular death in high-risk patients 55 and older with vascular disease or diabetes. It can be combined with thiazide diuretics.
Hypertension in adults
Heart failure after a heart attack
Cardiovascular risk reduction in adults 55+
Can be combined with thiazide diuretics
Olmesartan vs. Ramipril Pros and Cons
Olmesartan
Olmesartan is an ARB with simple once-daily dosing and a low rate of dry cough compared to ACE inhibitors like ramipril. It carries a rare but distinct risk of severe, delayed-onset diarrhea, and it costs more out of pocket than many generic ACE inhibitors.
Pros
Once-daily dosing, and doses above 40 mg add no extra benefit
Approved for children as young as 6
Less likely to cause dry cough or angioedema than ACE inhibitors
Cons
Costs more than generic ramipril, roughly $115 to $205 per month without insurance
Not recommended as initial therapy in patients 75+ or with liver impairment
Rare risk of sprue-like enteropathy (severe chronic diarrhea)
Ramipril
Ramipril is an ACE inhibitor with decades of outcomes data, including proven benefits for heart failure and cardiovascular risk reduction. Its most common side effect is a dry cough, and it carries a higher risk of angioedema than ARBs like olmesartan.
Pros
Proven to reduce death and hospitalization after heart-attack-related heart failure
Additional approval to lower cardiovascular risk in high-risk patients 55+
Typically much cheaper than olmesartan, often $8 to $30 per month as a generic
Cons
Dry cough affects up to 7% of patients, a known ACE inhibitor effect
Higher risk of angioedema than ARBs, especially in Black patients
Not FDA-approved for use in children
Common Symptoms and Related Diseases You Can Explore
Explore a range of common symptoms the Doctronic Symptom Checker can help you understand.