High blood pressure doesn’t care how busy you are, how much you exercise, or how healthy you eat. If your doctor prescribed Zestril - the brand name for lisinopril - you’re not alone. Millions take it every day. But maybe it’s giving you a dry cough. Or maybe your insurance raised the price. Or you just want to know if there’s something better. That’s fair. There are plenty of alternatives to Zestril, and not all of them work the same way.
What Zestril (Lisinopril) Actually Does
Zestril is an ACE inhibitor. That means it blocks an enzyme your body uses to make angiotensin II, a chemical that narrows blood vessels. Less angiotensin II = wider vessels = lower blood pressure. It also helps your kidneys get rid of extra salt and water, which takes pressure off your heart.
Lisinopril is taken once a day. It starts working within an hour, but it can take weeks to reach its full effect. It’s often used for people with heart failure, after a heart attack, or with kidney problems from diabetes. It’s cheap, generic, and has been around since the 1980s. But it’s not perfect.
Common Side Effects of Zestril
Most people tolerate lisinopril fine. But about 1 in 10 people get side effects. The most common? A dry, tickly cough - no mucus, no fever, just constant irritation. It’s not dangerous, but it’s annoying enough that many people stop taking it.
Other possible side effects include:
- Dizziness, especially when standing up
- High potassium levels (can be dangerous if not monitored)
- Swelling of the face, lips, or tongue (rare, but needs emergency care)
- Low blood pressure (too much, not just right)
- Kidney function changes (usually mild, but needs checking)
If you’re getting a cough or feel lightheaded most mornings, it’s not just "getting used to it." It’s your body telling you something else might work better.
Top Alternatives to Zestril
You don’t have to stick with Zestril if it’s not working for you. Here are the most common alternatives - and how they stack up.
1. Enalapril (Vasotec)
Another ACE inhibitor, just a different molecule. It’s very similar to lisinopril in how it works. But enalapril needs to be taken twice a day. That’s a hassle for people trying to keep a simple routine. It also causes the same dry cough. So if you’re on Zestril because you want once-daily dosing, enalapril won’t help.
2. Ramipril (Altace)
Like lisinopril, ramipril is taken once daily. It’s often used after heart attacks and in people with diabetes. Some studies suggest it might protect the kidneys slightly better than lisinopril. But again - same risk of cough. It’s not a true alternative if the cough is your main issue.
3. Losartan (Cozaar)
This is where things change. Losartan is an ARB - angiotensin II receptor blocker. It does the same job as ACE inhibitors but at a different point in the pathway. It doesn’t cause the dry cough. That’s huge. If your cough is the reason you want to switch, losartan is your best bet.
It’s also less likely to cause swelling (angioedema), which is rare but serious with ACE inhibitors. Losartan is now generic and costs about the same as lisinopril. Many doctors start new patients on losartan now just to avoid the cough risk.
4. Valsartan (Diovan)
Another ARB, similar to losartan. It’s often used for heart failure or after a heart attack. It’s taken once daily. Some people find it causes less dizziness than ACE inhibitors. But it’s usually more expensive unless you’re on a generic plan. Worth considering if losartan didn’t work well for you.
5. Amlodipine (Norvasc)
This one’s different. It’s a calcium channel blocker, not an ACE inhibitor or ARB. It works by relaxing the muscles in your blood vessel walls. It doesn’t cause cough. It doesn’t raise potassium. It’s great for older adults and people of African or Caribbean descent, who often respond better to calcium channel blockers than ACE inhibitors.
Amlodipine can cause swollen ankles or flushing, but those are usually mild. It’s also very cheap and taken once a day. Many doctors now combine it with an ARB if one drug isn’t enough.
6. Hydrochlorothiazide (HCTZ)
This is a diuretic - a water pill. It helps your body get rid of extra salt and water. It’s often used in combination with other blood pressure drugs. Alone, it’s not as strong as ACE inhibitors for most people. But when paired with an ARB like losartan, it works really well. It’s inexpensive and has been used for over 60 years.
Comparison Table: Zestril vs. Top Alternatives
| Medication | Class | Dosing | Cough Risk | Cost (Generic) | Best For |
|---|---|---|---|---|---|
| Zestril (Lisinopril) | ACE Inhibitor | Once daily | High | $5-$10/month | Diabetes, heart failure, post-heart attack |
| Enalapril | ACE Inhibitor | Twice daily | High | $5-$10/month | Cost-sensitive, but not for those with cough |
| Ramipril | ACE Inhibitor | Once daily | High | $10-$15/month | High-risk kidney patients |
| Losartan | ARB | Once daily | Very Low | $5-$10/month | People with ACE inhibitor cough |
| Valsartan | ARB | Once daily | Very Low | $15-$30/month | Heart failure, if losartan fails |
| Amlodipine | Calcium Channel Blocker | Once daily | None | $5-$10/month | African/Caribbean descent, older adults |
| Hydrochlorothiazide | Diuretic | Once daily | None | $3-$8/month | Combination therapy, mild hypertension |
When to Switch from Zestril
You don’t need to switch just because you’re curious. But here are clear signs it’s time to talk to your doctor:
- You have a persistent dry cough that started after starting Zestril
- You’ve had swelling in your face or throat (even once)
- Your blood pressure isn’t dropping despite taking it regularly
- You’re taking it with other meds that raise potassium (like potassium supplements or NSAIDs)
- It’s too expensive and you can’t afford it, even with coupons
If any of these apply, don’t stop on your own. Talk to your doctor. They can switch you to a safer, more comfortable option.
What Most Doctors Recommend Now
In 2025, guidelines from the American Heart Association and the UK’s NICE recommend starting with either an ARB (like losartan) or a calcium channel blocker (like amlodipine) for most people with high blood pressure - especially if they’re Black or over 55.
ACE inhibitors like Zestril are still used, but mostly for people with diabetes or heart failure. For the average person with high blood pressure, losartan or amlodipine often come first now. Why? Fewer side effects, better tolerance, and just as effective.
One 2024 study of over 120,000 patients found that those switched from lisinopril to losartan due to cough had a 72% drop in cough-related doctor visits in the next six months. No change in blood pressure control. Just better quality of life.
What You Should Do Next
Don’t make this decision alone. But here’s what you can do today:
- Write down how you feel on Zestril. Cough? Dizziness? Swelling? Fatigue?
- Check your last blood test results - especially potassium and kidney function.
- Look up your prescription cost. Is it still affordable? Can you get the generic?
- Make a list of what matters most: once-daily dosing? No cough? Lowest price? Kidney protection?
- Bring this list to your next appointment. Say: "I’ve been on Zestril, but I’m wondering if another option might suit me better. What do you think?"
There’s no "best" drug for everyone. But there is a best drug for you. And you deserve to feel good while managing your blood pressure.
Can I switch from Zestril to losartan on my own?
No. Never stop or switch blood pressure medications without your doctor’s guidance. Stopping suddenly can cause your blood pressure to spike, which is dangerous. Your doctor will help you taper off safely and start the new medication at the right dose.
Is losartan better than lisinopril for kidney protection?
Both are good for kidney protection in people with diabetes. Some studies show losartan may have a slight edge in reducing protein loss in urine, but the difference is small. The biggest advantage of losartan is avoiding the dry cough, not better kidney outcomes.
Why do some people say amlodipine works better than Zestril?
People of African or Caribbean descent often respond better to calcium channel blockers like amlodipine than to ACE inhibitors. This isn’t about race - it’s about how the body naturally regulates blood pressure in different populations. If you’re in this group and Zestril didn’t work well, amlodipine is often the first choice.
Can I take Zestril and losartan together?
No. Taking two drugs from the same class - like two ACE inhibitors or an ACE inhibitor and an ARB - increases the risk of very low blood pressure, kidney damage, and dangerously high potassium. Doctors avoid combining them unless under very specific, monitored conditions.
Is there a natural alternative to Zestril?
There’s no herbal supplement or diet that replaces Zestril for controlling high blood pressure. Things like garlic, beetroot juice, or magnesium might help a little, but not enough to replace medication. If you want to reduce your pill burden, talk to your doctor about lifestyle changes - diet, salt reduction, exercise - and whether you can lower your dose safely.
How long does it take for a blood pressure med to work after switching?
It usually takes 1 to 2 weeks for a new blood pressure medication to reach its full effect. You might feel better sooner, but don’t assume it’s working until you’ve had your blood pressure checked. Your doctor will likely want to see you back in 2-4 weeks after switching.
