Lisinopril And Stroke: What's The Connection?

Lisinopril is a drug used to treat high blood pressure (hypertension) and is also used to treat congestive heart failure and improve survival after a heart attack. It is part of a class of drugs called angiotensin-converting enzyme (ACE) inhibitors, which work by blocking the formation of a hormone that causes blood vessels to constrict. This helps blood vessels relax and allows blood to flow more easily, reducing blood pressure and the risk of heart attack and stroke. While Lisinopril is generally considered safe, it may cause serious side effects such as angioedema, low blood pressure, liver damage, kidney damage, and allergic reactions. It is important to consult a doctor before taking Lisinopril to ensure safe usage and avoid potential drug interactions.

Lisinopril's effectiveness in preventing stroke

Lisinopril is a drug used to treat high blood pressure (hypertension) and can be prescribed to patients within 24 hours of an acute ischemic stroke. It is an angiotensin-converting enzyme (ACE) inhibitor that works by relaxing the blood vessels, thereby lowering blood pressure and increasing the supply of blood and oxygen to the heart.

Effectiveness in Preventing Stroke

Observational studies have shown a link between high blood pressure and an increased risk of stroke. Lowering blood pressure can thus reduce the risk of strokes. However, the optimal treatment of hypertension in acute stroke is unclear, and previous randomised controlled trials of blood pressure-lowering agents have failed to show improved functional outcomes. This may be because treatment was commenced too late to be effective, or because interventions did not influence the mechanisms of progressive cerebral injury.

The earliest that acute stroke treatments could be initiated is during contact with paramedics, and a pilot randomised controlled trial (Paramedic Initiated Lisinopril for Acute Stroke Treatment, or PIL-FAST) is assessing the feasibility of paramedic-initiated lisinopril for hypertension early after the onset of acute stroke. The results will inform the design of a definitive RCT to evaluate the effects of very early blood pressure lowering in acute stroke.

Another study, the Controlling Hypertension and Hypotension Immediately Post Stroke (CHHIPS) trial, evaluated the effects of ACE inhibitor therapy in acute stroke patients. Lisinopril was included in a treatment arm of the trial, which found that ACE inhibitor therapy was less effective in preventing in-trial stroke than diuretic or calcium channel blocker therapy.

A separate study, the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), compared the ability of different classes of antihypertensive drugs to prevent stroke in an ethnically diverse population of high-risk, older hypertensive persons. ALLHAT found that stroke rates were higher with lisinopril than with chlorthalidone (a thiazide-type diuretic) or amlodipine (a calcium channel blocker) in-trial. However, there were no differences in the 10-year rates for the three treatment arms.

Among Blacks and women in ALLHAT, lisinopril treatment was less effective in preventing in-trial stroke than either chlorthalidone or amlodipine treatment, even after adjusting for treatment differences in systolic blood pressure. These differences abated by the end of the post-trial period.

While lisinopril has been shown to be an effective hypotensive agent, even at low dosages, the evidence for its effectiveness in preventing stroke is mixed. Further randomised controlled trials are needed to evaluate the effects of very early blood pressure lowering in acute stroke, particularly in an ethnically diverse population.

Lisinopril's side effects

Lisinopril is a prescription medicine used to treat high blood pressure (hypertension), heart failure, and to lower the risk of death in people after a heart attack. It works by blocking a substance in the body that causes the blood vessels to tighten, helping your blood vessels relax so that blood can move through them more easily.

Common side effects

Lisinopril has several common side effects, which occur in more than 1 in 100 people. These include:

• A dry, tickly cough that does not get better
• Feeling dizzy or lightheaded, especially when you stand up or sit up quickly
• Being sick (vomiting)
• Itching or a mild skin rash

Serious side effects

Although rare, some people may experience serious side effects when taking lisinopril. These include:

• Yellowing of the whites of the eyes or skin, which can be a sign of liver problems
• Feeling paler than usual, tired, faint, or dizzy, which can indicate a blood or bone marrow disorder
• Severe stomach pain, which can be a sign of an inflamed pancreas (acute pancreatitis)
• Swollen ankles or blood in urine, which can be signs of kidney problems
• Weakness on one side of the body, trouble speaking or thinking, loss of balance or blurred eyesight, which can be signs of a stroke
• Faster heart rate, chest pain and tightness, which can be signs of heart problems
• Shortness of breath, wheezing and tightening of the chest, which can be signs of lung problems

Long-term side effects

Taking lisinopril for a long time can sometimes cause your kidneys to not work as well as they should. Your doctor will check how well your kidneys are working with regular blood tests.

Lisinopril's overdose effects

Lisinopril is a prescription medicine used to treat high blood pressure, heart failure, and to improve survival after a heart attack. It belongs to a class of medications called angiotensin-converting enzyme (ACE) inhibitors, which work by relaxing the blood vessels, thereby lowering blood pressure and increasing the supply of blood and oxygen to the heart.

Lisinopril Overdose Effects

While Lisinopril is generally safe when taken as prescribed, overdosing on the medication can have serious consequences. The amount of Lisinopril that can lead to an overdose varies from person to person, but taking more than the prescribed dose can cause the following symptoms:

• Dizziness
• Sleepiness
• Pounding heartbeat (heart palpitations)
• Severe stomach pain
• Hives
• Difficulty breathing
• Swelling of the face, lips, tongue, or throat
• Nausea
• Weakness
• Chest discomfort, tightness, or heaviness
• Irregular heartbeat
• General feeling of discomfort or illness
• Muscle aches and pains

If you suspect that you or someone else has overdosed on Lisinopril, it is important to seek emergency medical attention or call the Poison Control center immediately. Do not try to induce vomiting unless instructed to do so by a medical professional. Bring the Lisinopril packet or leaflet, any remaining medicine, and any other medications you are taking with you to the hospital or poison control center.

Lisinopril's interactions with other drugs

Lisinopril is a common medication used to treat high blood pressure and other heart-related conditions. It is also used to treat heart failure and in some patients after a heart attack. Lisinopril is available in prescription form only and should be taken as advised by a doctor.

There are 402 drugs known to interact with lisinopril, 43 of which are major interactions, 329 are moderate, and 30 are minor. Some of the most frequently checked interactions include medicines such as Aspirin, Crestor, Cymbalta, Fish Oil, Flonase, Januvia, and Jardiance.

Lisinopril can interact with several medications, including diuretics, anti-inflammatory medicines, medicines to treat low blood pressure, and medicines that calm down the immune system. Lisinopril should not be taken with other angiotensin-converting enzyme inhibitors, such as enalapril and benazepril.

Some of the key interactions to be aware of include:

• Diuretics (water pills): Diuretics and lisinopril can together cause blood pressure that is too low (hypotension), leading to dizziness and potentially fainting.
• Diabetes medications: Lisinopril and diabetes medications can cause blood sugar to get too low (hypoglycemia), resulting in feelings of shakiness, hunger, and sweating.
• Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs are known to be hard on the kidneys, and taking them with lisinopril can worsen kidney function. NSAIDs can also increase blood pressure, reducing the effectiveness of lisinopril.
• Angiotensin II receptor blockers (ARBs): ARBs work very similarly to lisinopril, and taking them together may cause more side effects without additional benefits.
• Aliskiren: Aliskiren works along the same pathway as ARBs and lisinopril, and this combination may also lead to more side effects without added benefits.
• Certain cancer and transplant medications: Taking lisinopril with mTOR inhibitors can increase the risk of angioedema, a serious reaction where the face, mouth, and neck swell, causing difficulty in breathing.
• Lithium: Lisinopril can cause changes in sodium levels, affecting how lithium is removed from the body, potentially leading to lithium toxicity.

It is important to consult a healthcare provider about potential lisinopril interactions, especially when starting a new medication or supplement. Some interactions can be avoided with safer alternatives, while others may require dosage changes or close monitoring.

Lisinopril's effects on pregnancy

Lisinopril is not recommended for use during pregnancy, especially during the second and third trimesters. According to the Australian categorisation system, it is a category D drug, meaning it has been shown to cause increased incidence of human fetal malformations or irreversible damage in animals, and is suspected or may be expected to do the same in humans. In the US, it does not have a category, but the FDA has stated that the use of drugs that act on the renin-angiotensin system during the second and third trimesters increases the risk of morbidity and death in fetuses and newborns.

Animal studies have shown evidence of fetotoxicity, and in humans, exposure to angiotensin-converting enzyme (ACE) inhibitors, the class of drugs that includes lisinopril, during the second and third trimesters has been connected to fetal and neonatal toxicity and even fetolethality.

There is no data on the effects of lisinopril during the first trimester in humans, and it is not known whether it can make it harder to get pregnant or increase the chance of miscarriage. However, women who are pregnant or planning to become pregnant should be informed of the potential risks to the fetus.

Lisinopril can be passed on to newborns through breastmilk, and ACE inhibitors have been shown to adversely affect nursing infants.

Frequently asked questions