The usual answer when ramipril causes a cough — same benefit, without the cough.
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Losartan is an angiotensin receptor blocker — an ARB, or "sartan". It blocks the receptor that angiotensin II acts on, so blood vessels relax and blood pressure falls.
ACE inhibitors such as ramipril work one step earlier in the same pathway, by preventing angiotensin II from being made. That difference is why they cause a cough and ARBs do not: ACE inhibitors also allow bradykinin to accumulate, and bradykinin is what triggers the cough.
The blood pressure and kidney benefits are essentially equivalent.
Stop losartan temporarily during illness causing dehydration — vomiting, diarrhoea, or heat illness — and restart once eating and drinking normally.
This matters because losartan, an anti-inflammatory and a diuretic taken together during dehydration is a well-recognised cause of acute kidney injury.
Kidney function and potassium are checked before starting, one to two weeks after starting or any dose increase, and periodically after that. A small rise in creatinine is expected and acceptable.
Losartan does not cause the dry cough that ACE inhibitors do, which is its main practical advantage.
Anyone of childbearing age taking an ARB should know it must be stopped as soon as pregnancy is suspected, and should have a plan for what to switch to.
Monitor kidney function and potassium, and blood pressure.
Yes, to continue established treatment, and to switch someone from an ACE inhibitor who has developed the characteristic dry cough. That switch is straightforward and improves quality of life considerably.
What we need is recent kidney function and a blood pressure record — ideally home readings over a week rather than a single measurement.
We will not start blood pressure treatment on one reading. Diagnosis needs home or ambulatory monitoring, because white coat hypertension is common and treating it causes harm without benefit.
Losartan is an inexpensive generic and a month's supply on a private prescription usually costs less than the England NHS prescription charge.
Also available combined with hydrochlorothiazide in one tablet, which reduces the number of tablets where a diuretic is also needed.
Do not stop long-term blood pressure treatment without advice, other than the temporary sick day pause described above. Blood pressure rises again, usually silently.
A dry, tickly cough on ramipril affects a meaningful minority, is more common in women, and can begin months after starting. It is not a reason to put up with it — switching to losartan resolves it while keeping the benefit.
Reducing salt, losing weight, regular activity and cutting alcohol all lower blood pressure measurably, and for someone borderline may be enough on their own.
Almost always the dry cough, which ACE inhibitors cause and ARBs do not. The benefit is equivalent.
Yes — kidney function and potassium before starting, after any increase, and periodically. This is not routine box-ticking; it detects the two things that genuinely go wrong.
Take advice. The combination reduces the blood pressure benefit and, with a diuretic and dehydration, can injure the kidneys. Paracetamol is usually the safer choice.
No. It must be stopped as soon as pregnancy is suspected, and ideally before conceiving. Tell us if you are planning a pregnancy.
A small rise is expected and acceptable — it reflects how the drug changes pressure within the kidney, not damage. A large rise needs review.
Clinically reviewed by Dr Mohammad Zubair Khan, GMC 7563469
Last reviewed
August 30, 2026
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