The renin-angiotensin system works to control fluid levels and blood pressure in the body. Angiotensin I, a powerful vasoconstrictor, or substance in the body that causes blood vessels to constrict and narrow, requires the angiotensin converting enzyme (ACE) to change angiotensin I into a form that can cause vasoconstriction. Diovan blocks angiotensin receptors in the body, preventing it from having an effect, and lisinopril inhibits the ACE enzyme itself; both actions prevent vasoconstriction, which reduces blood pressure.
Hypotension
Both lisinopril and Diovan cause orthostatic hypotension, which is low blood pressure that occurs with position changes; however, the incidence of orthostatic hypotension is higher with lisinopril. The National Institute of Health (NIH) reports that hypotension was the cause for discontinuation of lisinopril in up to 5.3 percent of clinical trial subjects who had a history of heart failure, and as high as 9.7 percent for heart attack patients being treated with lisinopril. Diovan causes orthostatic hypotension in less than 1 percent of clinical trial participants, and symptoms appear to be dose-dependent, according to the NIH.
Cough
The NIH reports that a dry, non-productive cough occurs with all ACE inhibitors. In clinical trial subjects taking lisinopril, the rate of drug discontinuation due to dry cough was 3.5 percent. Symptoms of cough resolved after patients stopped lisinopril. In studies comparing Diovan to other ACE inhibitors, the incidence of dry cough among Diovan study participants was only 2.6 percent compared to 7.9 percent with the other ACE inhibitor group.
Headache
According to “Pearson Nurse’s Drug Guide 2010,” headache and dizziness are side effects caused by both lisinopril and Diovan. With lisinopril, the symptoms of headache and dizziness frequently accompany low blood pressure, and should be reported to the prescribing physician. The NIH reports that headache and dizziness were the most common adverse effects experienced by Diovan users, requiring discontinuation of the drug in 2.3 percent of subjects.
Angioedema
Although a rare adverse reaction, angioedema has been reported by patients taking lisinopril. Angioedema, or swelling of the face, eyes, mouth, lips and throat, requires immediate medical attention and drug discontinuation. A reaction can occur at any time during treatment with ACE inhibitors, particularly lisinopril. Angioedema can also occur in the bowel, with symptoms such as nausea, vomiting and abdominal pain. Patients should seek medical care for these symptoms.
References
- DailyMed: Lisinopril
- “Pearson Nurse’s Drug Guide 2010”; Wilson, B. A., Shannon, T. M., & Shields, K. M.; 2010
- DailyMed: Diovan
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