Does lisinopril lower heart rate?

In this article:

• Does lisinopril lower heart rate?
• How lisinopril works
• Lisinopril and heart rate
• Common side effects
• Monitoring heart health
• When to see a provider

In this article

• Does lisinopril lower heart rate?
• How lisinopril works
• Lisinopril and heart rate
• Common side effects
• Monitoring heart health
• When to see a provider

Lisinopril, also sold under the brand name Zestril, is a commonly prescribed antihypertensive medication used to lower high blood pressure and protect the heart. Like any medication, it can cause side effects, though the most frequent ones—such as dry cough, dizziness, or headache—are typically mild. Still, many people taking lisinopril wonder whether it can also affect their heart rate. Here’s what to know about how lisinopril works and whether it plays a role in slowing or changing your heartbeat.

Can lisinopril lower heart rate?

When your blood pressure drops, your body may respond by making your heart beat faster. Because lisinopril decreases high blood pressure, some assume that it must also directly affect heart rate. But it doesn’t act on the heart; it relaxes blood vessels. “By itself, lisinopril does not directly slow the heart or speed it up, because it affects large blood vessels rather than the heart’s electrical system,” explains Geny Augustine, MD, a family medicine provider with Solace Health in Phoenix, Arizona. Yet, there are certain circumstances when you might notice heartbeat changes while taking lisinopril. For example, when taking lisinopril with certain other medications. 

This effect, like most side effects, is most likely to occur when you first start on the medication or when your provider increases your dose. “I sometimes see patients have a reflex increase in their heart rate when their blood pressure drops rapidly, say, if they are beginning to take the drug or increasing the dose,” adds Dr. Augustine.

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How lisinopril works

You may know that lisinopril lowers blood pressure, thereby reducing the risk of experiencing a heart attack (also known as myocardial infarction) or stroke. However, most don’t know how it achieves that goal.

Lisinopril belongs to a class of medications known as angiotensin-converting enzyme inhibitors, commonly referred to as ACE inhibitors. The American College of Cardiology/American Heart Association (ACC/AHA) recommends ACE inhibitors as first-line agents for managing hypertension. 

It works by blocking the conversion of one protein (angiotensin I) into another (angiotensin II), which would cause the blood vessels in the body to constrict, or tighten. When you take lisinopril, it helps the blood vessels relax, making it easier for blood to flow through them and transport oxygen to the heart. The result: your blood pressure decreases. The improved blood flow also reduces the strain on the heart muscle, which has to work harder to pump blood when you have high blood pressure.

In addition to ACE inhibitors, other classes of blood pressure medication include:

• Diuretics, also known as water pills
• Beta blockers
• Angiotensin II receptor blockers (ARBs)
• Calcium channel blockers

Sometimes, diuretics, beta blockers, or calcium channel blockers are prescribed in combination with an ACE inhibitor, such as lisinopril, when treating heart failure or when additional blood pressure control is needed.

When your heart rate might change on lisinopril

Not everyone’s heart rate will change when taking lisinopril. However, if you take lisinopril along with certain other medications, it could affect your heart rate. “Many people taking lisinopril are also prescribed other medications that can slow the heart rate,” says Anneli Kumpula, NP, a family and psychiatric nurse practitioner and co-founder of Elevate Hospice in Phoenix, Arizona. 

Possible culprits include:

• Beta blockers such as metoprolol or atenolol
• Calcium channel blockers, such as diltiazem and verapamil
• Potassium-sparing diuretics, such as spironolactone

“These medications are often used together safely, but they can lower heart rate too much in some individuals,” Kumpula says. She suggests watching out for signs such as dizziness, lightheadedness, unusual fatigue, or feeling faint.

“Combining it with potassium-sparing substances may lead to fatigue and palpitations from high potassium,” Dr. Augustine adds.

It’s essential to inform your healthcare provider about all medications and supplements you are taking, as this will help you avoid potential interactions with lisinopril (or other possible drug interactions). 

Common side effects of lisinopril

The most common side effects of lisinopril include coughing, dizziness or lightheadedness, and headache. However, occasionally, people may experience more serious side effects. 

More serious effects that require emergency medical attention include:

• Allergic reactions
• Angioedema (swelling under the skin)
• High potassium levels
• Kidney problems or damage to the kidneys
• Liver injury
• Low blood pressure

If you experience any new or unusual side effects, notify your healthcare provider as soon as possible. When you have high blood pressure, it’s important to check with your healthcare provider before taking any other medications, as certain common cold, flu, or pain medications may affect your heart rate or blood pressure.

People with renal artery stenosis or a history of allergic reactions should not take lisinopril, as it’s contraindicated in these circumstances, according to Zheryl Sounthala, DNP-FNP, the APC program director at the Swedish Heart & Vascular Institute in Seattle. 

Monitoring your heart health while on lisinopril

Even after you’re prescribed medication to treat high blood pressure, you should take steps to track and protect your heart health.

The American Heart Association (AHA) recommends that individuals diagnosed with high blood pressure regularly monitor their blood pressure at home. These checks are especially important when starting a new hypertension medication or changing a dose. Discuss with your healthcare provider the best time of day to take your blood pressure reading, as healthcare providers often recommend taking it at the same time each day. Your provider may also request that you track your blood pressure readings using an automatic, cuff-style, upper-arm (biceps) monitor. 

It’s important to note: Even if your home monitoring shows your blood pressure improves, do not stop taking your medication without checking with a healthcare professional.

When to see your healthcare provider

If, at any point during lisinopril treatment, you notice anything feels off or wrong, contact your healthcare provider. “If someone is unsure whether their medications may interact or affect heart rate, the safest approach is to review the full medication list with their healthcare provider or pharmacist,” Kumpula says.

Also, if you begin to experience any symptoms that could signal a serious adverse effect, it’s also important to seek medical attention. “Side effects which would cause a patient to seek emergency care include angioedema (swelling of the face, lips, tongue, or throat, which can occur in 0.1-0.7% of patients), or a severe allergic reaction including chest tightness and swelling of the throat,” says Sounthala.