Last updated on March 4th, 2025 at 10:37 am
If you’re comparing Lisinopril vs Entresto, chances are you or a loved one are dealing with heart issues. Maybe it’s high blood pressure. Maybe it’s angina heart failure. Either way, you want to know which medication is better. The right choice will make a huge difference in your health, your energy levels, and even how long you live.
Both drugs treat heart-related conditions, but they work very differently. One is a tried-and-true affordable option. The other is a newer, more advanced treatment. So, which one should you choose? Let’s break it all down in simple terms so that you will make the best decision for your heart health.
How Lisinopril and Entresto Work (Mechanism of Action)
First, let’s talk about how these medications work. Lisinopril and Entresto both help your heart, but they do it in very different ways.
Lisinopril: The ACE Inhibitor
Lisinopril is an ACE inhibitor (angiotensin-converting enzyme inhibitor). That’s a fancy way of saying it blocks a chemical called angiotensin II. This chemical makes blood vessels tighten, which raises blood pressure. By blocking it, Lisinopril helps your blood vessels relax. This lowers your blood pressure and reduces strain on your heart.
Entresto: A Dual-Action Drug
Entresto works differently. It’s a combination of two drugs: Sacubitril and Valsartan.
- Sacubitril is a neprilysin inhibitor. It increases heart-protective substances that help blood vessels relax and reduce fluid buildup.
- Valsartan is an angiotensin receptor blocker (ARB). It blocks angiotensin II, like Lisinopril, but in a different way. This prevents blood vessel tightening and helps lower blood pressure.
Key Difference: One vs. Two Pathways
Lisinopril only blocks one pathway (angiotensin II). Entresto works on two pathways (angiotensin II + neprilysin). That makes Entresto a more advanced option, especially for heart failure.
When Are They Prescribed? (Approved Uses & Indications)
Both drugs treat heart-related conditions, but their uses are different. Knowing this helps you see which one fits your needs.
Lisinopril is Used For:
- High blood pressure (hypertension) – It’s one of the most commonly prescribed meds for this.
- Heart failure (HFrEF) – It helps, but it’s not the most powerful option.
- Post-heart attack care – Doctors often prescribe it after a heart attack to prevent future heart problems.
Entresto is Used For:
- Heart failure with reduced ejection fraction (HFrEF) – This is its main job. It’s much better at preventing hospitalizations and death than older meds.
- Heart failure with preserved ejection fraction (HFpEF) (under research) – Some doctors may use it, but it’s not officially approved for this yet.
(Wondering about the Entresto price? Discover the price of Entresto in the link.)
Lisinopril vs Entresto- The Main Difference
If you have high blood pressure, Lisinopril is the clear choice. If you have heart failure, Entresto is the stronger option.
Which One Works Better? (Effectiveness Comparison)
Effectiveness is the most important thing, right? Let’s compare how well these drugs work.
For Heart Failure (HFrEF)
If you have heart failure with reduced ejection fraction (HFrEF), studies show Entresto is better than Lisinopril.
- The PARADIGM-HF trial compared Entresto to Lisinopril in heart failure patients.
- Patients on Entresto had 20% fewer hospitalizations and lived longer.
- This means Entresto is the preferred choice for heart failure.
For High Blood Pressure (Hypertension)
- Lisinopril is better for high blood pressure. It’s one of the most commonly prescribed drugs for hypertension.
- Entresto is not a first-line treatment for hypertension.
Final Verdict
- For heart failure: Entresto wins.
- For high blood pressure: Lisinopril wins.
Side Effects and Safety Concerns
All medications have side effects. Let’s see how these two compare.
Common Side Effects (Both Drugs)
- Low blood pressure (dizziness, fainting)
- High potassium levels (can affect your heart)
- Kidney issues (especially in people with kidney disease)
Unique Side Effects
- Lisinopril: Persistent dry cough (annoying but harmless)
- Entresto: Higher risk of angioedema (severe facial/throat swelling, which can be life-threatening)
Key Takeaway
Lisinopril can cause an annoying cough. Entresto has a higher risk of severe swelling (angioedema). If you had angioedema on Lisinopril, you can’t take Entresto.
Cost and Insurance Coverage Comparison
Lisinopril
✔ Cheap and widely available
✔ Costs around $10–$20 per month
✔ Fully covered by most insurance plans
Entresto
✔ Expensive (around $500–$600 per month without insurance)
✔ Requires insurance approval
✔ Some patients qualify for financial assistance programs
Which One is More Affordable?
Lisinopril is a budget-friendly option. Entresto is expensive but more effective for heart failure.
Switching Between Lisinopril and Entresto
Can You Switch From Lisinopril to Entresto?
If you have heart failure, your doctor might switch you to Entresto because it works better.
BUT… there’s a rule: You need to wait 36 hours after stopping Lisinopril before taking Entresto. This prevents a dangerous reaction called angioedema.
Can You Switch From Entresto to Lisinopril?
You can, but it’s not ideal. If you can’t afford Entresto, your doctor may switch you back to Lisinopril. (Learn how to switch from Entresto to Lisinopril)
Which One Should You Choose? (Final Decision Guide)
Pick Lisinopril if:
✔ You need an affordable option.
✔ You have high blood pressure.
✔ You have mild heart failure and can’t take Entresto.
Pick Entresto if:
✔ You have heart failure (HFrEF) and want the best treatment.
✔ You’ve been on Lisinopril but need something stronger.
✔ You can afford it (or have insurance coverage).
People are Asking:
Why switch from Lisinopril to Entresto?
Entresto is more effective at preventing hospitalizations and deaths in heart failure patients.
Can you take Lisinopril and Entresto together?
Taking both Lisinopril and Entresto together can cause dangerously low blood pressure and high potassium.
Is Entresto better than Lisinopril for high blood pressure?
Entresto is not a first-line treatment for hypertension.
So, which one is better? It depends on your condition. If you have high blood pressure, stick with Lisinopril. If you have heart failure, Entresto is the superior choice.
Talk to your doctor to see which one is right for you. Your heart deserves the best care!
Summary Table
Lisinopril vs Entresto: A Comprehensive Comparison
| Feature | Lisinopril | Entresto |
|---|---|---|
| Drug Class | ACE inhibitor | Lowers blood pressure, but is more effective in heart failure treatment |
| Main Ingredients | Lisinopril | Sacubitril/Valsartan |
| Primary Use | Hypertension, Heart Failure | Heart Failure (HFrEF) |
| Mechanism of Action | Blocks Angiotensin-Converting Enzyme (ACE) to reduce blood pressure | Inhibits neprilysin and blocks angiotensin II to enhance heart function |
| Effect on Blood Pressure | Lowers blood pressure | Lowers blood pressure, but more effective in heart failure treatment |
| Mortality Reduction | Reduces risk of death in heart failure patients | Proven to further reduce heart failure-related deaths compared to ACE inhibitors |
| Side Effects | Cough, dizziness, kidney issues, increased potassium | Hypotension, increased potassium, angioedema, kidney issues |
| Risk of Angioedema | Moderate | Higher than Lisinopril |
| Use with ARBs | Not recommended | Contains Valsartan (ARB) |
| Need for Washout Period | Not applicable | Requires a 36-hour washout period if switching from an ACE inhibitor |
| FDA Approval | Approved for hypertension and heart failure | Approved specifically for heart failure (HFrEF) |
| Cost | Generally cheaper, generic available | More expensive, brand-name only |
| Insurance Coverage | Widely covered | May require prior authorization |
Both medications have their strengths, but Entresto is often preferred for heart failure patients due to its superior effectiveness in reducing mortality. However, Lisinopril remains a reliable and more affordable option, particularly for those with hypertension. Can you take Entresto with lisinopril?… Learn more in the link.