Which to choose?
Enalapril: first choice for hypertension and, above all, heart failure. Losartan: patients with ACE inhibitor cough, hyperuricaemia or gout, or ACE inhibitor intolerance. Do not combine the two (renal and hyperkalaemia risk).
Point-by-point comparison
EnalaprilACE inhibitor
Brands: Innovace · Vasotec
VS
LosartanARB (angiotensin receptor blocker)
Brands: Cozaar
| Enalapril | Losartan | |
|---|---|---|
| Mechanism | Inhibits ACE, reducing conversion of angiotensin I to II. Vasodilation and lower aldosterone. | Selectively blocks the AT1 receptor, reducing vasoconstriction and aldosterone secretion. |
| Indications | Hypertension, heart failure, renal protection in diabetes. | Hypertension, heart failure (alternative to ACE inhibitors), diabetic renal protection. |
| Adult dose | 5-40 mg/day (1-2 doses). | 50-100 mg/day. |
| Onset of effect | 1-2 h | 1-2 h |
| Duration of effect | 12-24 h | 24 h |
| Pregnancy | CONTRAINDICATED (teratogenic, fetal anuria). | CONTRAINDICATED. |
| Breastfeeding | Compatible. | Limited data — avoid. |
| Paediatric use | Paediatric use with dose adjustment. | From 6 years. |
| Advantages | Most experience. Very low cost. Best evidence in heart failure. | Does not cause dry cough. Better tolerated. Lowers uric acid (useful in gout). |
| Disadvantages | Dry cough (10-15%), risk of angioedema (rare but serious). | Slightly more expensive. Blood-pressure lowering equivalent to an ACE inhibitor, not superior. |
Source: BNF, ESC guidelines, NICE NG136
For guidance only. This does not replace the pharmacist's judgement or medical advice. Check the official Summary of Product Characteristics before any clinical decision.
Frequently asked questions
Which is better, enalapril or losartan?
Enalapril: first choice for hypertension and, above all, heart failure. Losartan: patients with ACE inhibitor cough, hyperuricaemia or gout, or ACE inhibitor intolerance. Do not combine the two (renal and hyperkalaemia risk).
Can enalapril or losartan be taken in pregnancy?
Enalapril: CONTRAINDICATED (teratogenic, fetal anuria). Losartan: CONTRAINDICATED. Always ask a doctor or pharmacist before taking a medicine in pregnancy.
And while breastfeeding?
Enalapril: Compatible. Losartan: Limited data — avoid.