If you're taking Zestril for high blood pressure, you might be wondering if there’s a better option. Maybe your doctor mentioned alternatives, or you’re dealing with side effects like a dry cough or dizziness. You’re not alone. Millions take lisinopril - the generic name for Zestril - but many switch at some point. This isn’t about ditching your meds. It’s about finding what fits your body, lifestyle, and health goals.
What Zestril (Lisinopril) Actually Does
Zestril is a brand name for lisinopril, an ACE inhibitor. It works by blocking an enzyme that tightens blood vessels. When that enzyme is slowed, vessels relax, and blood pressure drops. It’s been around since the 1980s and is one of the most prescribed blood pressure pills in the U.S. and New Zealand.
Lisinopril is usually taken once a day. Doses range from 2.5 mg to 40 mg, depending on your condition. It’s often used for hypertension, heart failure, and after heart attacks. It’s cheap, effective, and has a long safety record. But it’s not perfect.
Common side effects include dry cough (affects up to 20% of users), dizziness, fatigue, and sometimes high potassium levels. Rare but serious risks include angioedema - swelling of the face, lips, or throat - which needs emergency care. If you’re African American, lisinopril may be less effective on its own, and your doctor might combine it with another drug.
Losartan (Cozaar): The Top Alternative
If your dry cough from lisinopril is driving you crazy, losartan (brand name Cozaar) is often the next step. It’s an ARB - angiotensin II receptor blocker. Like ACE inhibitors, it lowers blood pressure by relaxing vessels. But it doesn’t trigger the same cough-causing chemicals.
Studies show losartan works just as well as lisinopril for lowering blood pressure. In one large trial, both drugs reduced systolic pressure by about 12-15 mmHg after 12 weeks. But only 2-3% of people on losartan reported coughing, compared to 15-20% on lisinopril.
Losartan also has a bonus: it’s been shown to protect kidneys in people with diabetes and high blood pressure. That’s why it’s often chosen for diabetic patients. It’s also taken once daily, and side effects are usually mild - dizziness, fatigue, or occasional muscle cramps.
One downside? Losartan can be slightly more expensive than generic lisinopril, though prices vary. In New Zealand, both are covered under the Pharmaceutical Schedule, so out-of-pocket costs are low.
Valsartan (Diovan): Another ARB Option
Like losartan, valsartan (Diovan) is an ARB. It’s another solid alternative if you can’t tolerate lisinopril. Valsartan has a longer half-life, meaning it stays active in your body longer. Some people find they feel more consistent energy levels with valsartan compared to other ARBs.
It’s often prescribed for heart failure and post-heart attack care, just like lisinopril. In head-to-head trials, valsartan and lisinopril showed similar blood pressure control. But valsartan had fewer reports of cough and slightly lower rates of dizziness.
One thing to watch: valsartan was part of a major recall in 2018 due to a contaminant. That issue was fixed, and current batches are safe. If you’re prescribed valsartan now, make sure it’s from a reputable pharmacy.
Amlopidine (Norvasc): A Calcium Channel Blocker
Not everyone responds well to ACE inhibitors or ARBs. That’s where amlodipine (Norvasc) comes in. It’s a calcium channel blocker - a completely different class of drug. Instead of targeting the renin-angiotensin system, it relaxes the muscles in your artery walls by blocking calcium from entering them.
Amlodipine is especially effective for older adults and people of African or Caribbean descent, who often respond better to calcium channel blockers than ACE inhibitors. It’s also good for treating chest pain (angina).
Side effects? Swelling in the ankles or feet is common - about 10% of users. Some feel flushed or dizzy. But no cough. No kidney-related potassium spikes. It’s often combined with lisinopril if one drug alone isn’t enough.
It’s taken once daily, and it’s very affordable. In fact, generic amlodipine is often cheaper than lisinopril in many pharmacies.
Hydrochlorothiazide: The Diuretic Choice
Hydrochlorothiazide (HCTZ) is a thiazide diuretic - a water pill. It lowers blood pressure by helping your kidneys flush out extra salt and water. It’s not as strong as ACE inhibitors on its own, but it’s often added to them for better control.
Many doctors start with HCTZ in older patients or those with mild hypertension. It’s been used since the 1950s and has solid long-term data showing it reduces stroke risk.
Side effects include frequent urination (especially at first), low potassium, dizziness, and increased blood sugar. If you have gout or diabetes, your doctor will monitor you closely. It’s usually taken in low doses - 12.5 mg to 25 mg daily.
Combining HCTZ with lisinopril is common. In fact, many brands (like Zestoretic) already mix the two. If you’re on a combo pill, switching to a different combo - say, losartan + HCTZ - might be easier than switching the whole regimen.
Other Options: Metoprolol, Doxazosin, and More
There are other classes too. Metoprolol, a beta-blocker, is often used if you have heart rhythm issues or angina alongside high blood pressure. It’s not first-line for pure hypertension anymore, but it still has a place.
Doxazosin, an alpha-blocker, is sometimes used for men with enlarged prostates and high blood pressure. It can cause dizziness, especially when standing up.
For people with resistant hypertension - blood pressure that won’t drop even on three drugs - doctors might add spironolactone, a potassium-sparing diuretic. But that requires careful monitoring for potassium levels.
The point? There’s no single best drug. Your ideal choice depends on your age, ethnicity, other health issues, side effects, and cost.
How to Decide: A Simple Decision Guide
Here’s how to think about your options:
- If you have a dry cough → Switch to an ARB like losartan or valsartan.
- If you’re African or Caribbean descent → Consider a calcium channel blocker like amlodipine, or add a diuretic.
- If you have diabetes and kidney concerns → Losartan is often preferred.
- If you’re over 65 → HCTZ or amlodipine are common first choices.
- If your BP isn’t controlled on one drug → Talk about combo pills (like lisinopril + HCTZ or losartan + amlodipine).
- If cost is an issue → Generic lisinopril and amlodipine are usually the cheapest.
Don’t switch on your own. Talk to your doctor. But knowing these options helps you ask better questions.
What About Natural Alternatives?
Some people look to supplements - garlic, hibiscus tea, magnesium - to lower blood pressure. These can help a little, but they’re not replacements for prescription meds.
A 2023 meta-analysis found hibiscus tea lowered systolic pressure by about 7 mmHg on average. That’s less than what lisinopril does. Garlic showed similar small drops. Magnesium helped slightly in people with low levels.
These aren’t magic. But they can support your meds. If you’re eating more vegetables, walking daily, cutting salt, and losing weight, your blood pressure might drop enough to reduce your pill dose. Always tell your doctor if you’re using supplements - some interact with blood pressure drugs.
When to Stay on Zestril
Just because alternatives exist doesn’t mean you need to switch. If lisinopril is working, you have no side effects, and your kidneys and potassium levels are stable - stick with it. It’s one of the most studied, safest, and cheapest options out there.
Many people take it for years without issue. The goal isn’t to find the "best" drug. It’s to find the one that keeps you healthy, with the fewest side effects and the easiest routine.
Final Thoughts
There’s no single answer to "What’s better than Zestril?" It depends on you. Your body, your history, your lifestyle. Losartan is the most common switch for cough. Amlodipine works better for some ethnic groups. HCTZ is great for older adults. And combo pills are often the real solution.
The key is to have a conversation with your doctor - not just a prescription refill. Ask: "Is this still the best option for me?" "Are there side effects I should watch for?" "What happens if I switch?"
High blood pressure isn’t a one-size-fits-all problem. Your treatment shouldn’t be either.
Can I switch from Zestril to losartan on my own?
No. Never stop or switch blood pressure medications without talking to your doctor. Even if you’re switching to a similar drug like losartan, your dose needs to be adjusted carefully. Stopping suddenly can cause your blood pressure to spike, which increases your risk of stroke or heart attack. Your doctor will guide you through a safe transition.
Is lisinopril better than losartan for kidney protection?
Both drugs protect the kidneys in people with diabetes and high blood pressure. Studies show losartan may have a slight edge in reducing protein loss in urine - a sign of kidney damage - especially in type 2 diabetes. But lisinopril is still very effective. The choice often comes down to side effects: if you get a cough on lisinopril, losartan is the clear next step.
Why is amlodipine recommended for African descent patients?
People of African or Caribbean descent tend to have lower levels of renin - the enzyme ACE inhibitors like lisinopril target. This makes ACE inhibitors less effective on their own. Calcium channel blockers like amlodipine work through a different pathway and are often more effective in this group. Guidelines from the American Heart Association and New Zealand’s Health Ministry recommend calcium channel blockers or diuretics as first-line for these patients.
Can I take lisinopril and amlodipine together?
Yes, many people take both. In fact, combination pills like Caduet (amlodipine + atorvastatin) exist, and doctors often prescribe lisinopril and amlodipine as separate pills. They work in different ways, so together they often control blood pressure better than either alone. Watch for increased swelling in the ankles - a common side effect of amlodipine - and report it to your doctor.
Does lisinopril cause weight gain?
Lisinopril doesn’t typically cause weight gain. In fact, some people lose a small amount of weight due to reduced fluid retention. If you’ve gained weight while on lisinopril, it’s more likely due to other factors - diet, lack of movement, or another medication. Diuretics like HCTZ can cause temporary weight loss from water loss, but that’s not the same as fat loss.
Are there foods I should avoid with lisinopril?
Yes. Lisinopril can raise potassium levels, so avoid high-potassium salt substitutes (like NoSalt or Nu-Salt), large amounts of bananas, oranges, potatoes, spinach, or tomato products if you’re also taking potassium supplements. Your doctor will check your potassium levels regularly - especially if you have kidney issues or diabetes.
Jillian Fisher
I switched from lisinopril to losartan last year after the cough got unbearable. No more 3am hacking fits. Also noticed my energy improved. Weird how such a small change made such a big difference.
On October 28, 2025 AT 03:00