Lisinopril Side Effects Can Be Life Threatening: Beware Angioedema and ACE Inhibitors!

Keeping blood pressure under control is extremely important, since hypertension (high blood pressure) is a major risk factor for both stroke and heart disease. In many cases, the best medication may be an ACE inhibitor (ACEi). At last count over 18 million Americans take lisinopril. But this and other ACEi drugs are not safe for everyone. Some people experience a potentially deadly reaction called angioedema that they must never ignore. Others develop an incredible cough that disrupts their quality of life. A new study published in the European Heart Journal (Aug. 3, 2026) suggests that doctors may be able to determine in advance who will benefit and who will experience unacceptable adverse drug reactions.

Finding the correct blood pressure medication for a given individual is not as easy as many healthcare professionals may think. The prescriber may have to resort to trial and error to find a treatment that is effective without causing unwanted reactions.

Popularity Does Not Equal Safety

Just because ACE inhibitors such as lisinopril are the most prescribed blood pressure drugs in the United States does not make them great. As you will read shortly, many visitors to this website have had challenging experiences with lisinopril.

Doctors have a hard time predicting who will and who won’t tolerate  medications such as:

The researchers looked at how many people bailed out on their blood pressure medicine:

“Rate of antihypertensive switching ranged from 11% in ARB to 32% in ACEI, and the median switch time was 4–5 months across antihypertensive classes.”

That is a dramatic amount of switching! Almost one third of the patients started on a drug like lisinopril gave up after a few months. By the way, you may want to know what a somewhat similar drug is. There is a substantial difference between an angiotensin enzyme “inhibitor” and an angiotensin “blocker.” You can learn lots more about the difference between an angiotensin inhibitor and an angiotensin blocker in our eGuide to Blood Pressure Solutions.

ARBs are angiotensin receptor blockers and include:

• Losartan
• Olmesartan
• Telmisartan
• Valsartan

What Did the International Team of Researchers Discover?

The bottom line from the European Heart Journal (Aug. 3, 2026) suggests that there are specific genetic variants associated with the ACE inhibitor cough. While a cough may seem a minor side effect, it can be extremely disruptive and make sleeping difficult.

Angioedema is another complication of ACE inhibitors. In this condition, the face, lips and tongue may swell and interfere with breathing. In addition, a little-recognized condition involves intestinal angioedema. When parts of the digestive tract swell and/or close off, the situation can also become life threatening.

The new genetic research could help physicians identify patients for whom ACE inhibitor therapy is not likely to be a good choice.

Lisinopril Cough and Angioedema

This reader wants to know more about lisinopril ASAP:

Doctor Insists: Start Lisinopril Immediately!

Q. My doctor is concerned about my blood pressure and wants me to begin taking lisinopril. I have two questions: what BP monitors are reliable and what can you tell me about lisinopril? I would prefer a natural approach, but my doctor is adamant that I start the meds immediately.

A. We are big supporters of home blood pressure monitoring. Consumer Reports has been evaluating such devices for decades. The Omron brands generally rate very highly in their tests. Here is a link to a specific recommendation and the proper strategy for taking your blood pressure accurately.

ACE Inhibitors:

Health care providers prescribe lisinopril (Prinivil, Zestril) more than most other blood pressure medications in the world.  At last count, over 18 million Americans were taking it. It belongs to a class of drugs called ACEis (angiotensin converting enzyme inhibitors) that includes:

Such drugs are effective for helping control hypertension and many people take these medications without experiencing any side effects. That’s the good news.

Side effects may include dry cough, kidney problems, headache, fatigue, sensitivity to sunlight, hand tremors and dizziness upon standing. High potassium levels can occur, especially if the drug is combined with certain other medications. Always check with the pharmacist about dangerous drug interactions.

Angioedema Is a Serious Reaction to ACE Inhibitors:

The bad news is that some people are susceptible to a potentially lethal complication of ACE inhibitors called angioedema. It is considered rare complication. In this condition, tissues around the face and neck can swell rapidly. Without immediate emergency treatment, angioedema can be life threatening.

The symptoms can surface within a few hours or days after starting on the drug. But even people who have been on an ACE inhibitor for months or years can develop angioedema. Although both physicians and patients may find that counterintuitive, it is a well established phenomenon. The pandemic may have made this problem even worse, because of the affinity SARS-C0V-2 has for the ACE2 receptor (BMJ Case Reports, Sept. 9, 2020).

Medical Emergency!

At the very first symptoms of swelling do not delay: CALL 911 and be transported to an emergency department instantly! Don’t just take our word for it.

Here is a report posted to our website from Dennis:

“On October 8, I saw my doctor and was prescribed 20 mg of lisinopril 3 times a day. I thought, ‘Great, now I have some meds to help with my high blood pressure.’ I think it was around 185 over 110, which the doctor said was pretty high.

“By the 12th of October, my tongue had been swelling every day to the point that breathing was getting very difficult. This was all happening by the fourth day of taking my new blood pressure medicine.

“My son took me to the ER on the 12th. The nurse in ER took my readings and said my blood pressure was in heart attack territory at 225 over 170. I was taken back to a room to be examined, as my tongue was swelling so much. Not one doctor knew what to do. I really thought I was going to die from suffocation, as breathing was almost impossible at this point.

An Induced Coma

“By this time other family members were arriving and for two weeks I don’t remember anything other than what I was later told by family and doctors. The doctors put me in an induced coma. Doctors had to do surgery and perform a tracheotomy so I could breathe during my coma.

“They diagnosed me with angioedema caused by taking lisinopril!

“During my coma I developed pneumonia and also had to be put on dialysis. The doctors told my family that they should all be nearby because I wasn’t expected to live through this ordeal. They told family members only about a half percent of patients make it through a situation like mine.

“When I woke up from my coma after two weeks, I couldn’t walk, talk, or even write a simple sentence. I started my therapy in the hospital and it sure was difficult. After great hospital care and help from family and rehab, I was able to walk and talk and write again. It seemed like it took forever, but my goal was to do my rehab and be home by Thanksgiving. I pushed hard and did accomplish my goal but I don’t think I deserved to almost die and lose two months of my life for something that was not my doctor’s fault or mine.

“When my doctor saw me next he let me know he was so sorry and told me he kept checking up on my health daily. He even cried when we talked about my ordeal. People taking lisinopril need to know about the hazards of this drug.”

Another Testimonial About Angioedema:

Dennis was lucky indeed to have survived. His angioedema reaction came on within days of starting lisinopril. Other people may let down their guard because they have taken an ACE inhibitor safely for years.

Here is Ruth’s story:

“My brother was on lisinopril for two to three years with no problems other than an irritating cough. However, last month he woke up with a very swollen tongue. By the time he got to the ER, his respirations were down to about 85% and he was having trouble talking.

“The ER called for an emergency triage and the ER doctor came out, rushed him into a room, actually helping strip his clothes on the way. They gave him adrenaline, and IVs. They told him if he had been a little later waking up he might not have made it, and that most people with this serious a reaction can end up on a ventilator.

“Don’t mess with swelling of the mouth or trouble breathing. It could be a bad reaction. We are only five minutes from the hospital, and he was terribly close to stopping breathing and ending up on a ventilator.”

Symptoms of Angioedema:

Any swelling of tissues around the face, mouth and throat are a tip-off that something bad is happening. Some people report numbness or decreased feeling in the affected area. The eyes and lips can also be involved. If the throat and tongue swell, there can be the sensation of throat tightness and breathing can become difficult or impossible. Now you understand why this is a medical emergency! Physicians who have studied this complication emphasize that once a person has experienced angioedema, they must never take an ACE inhibitor again (Current Hypertension Reports, June 8, 2018).

Abdominal Angioedema:

Angioedema is not restricted to the head and neck. Hands and genitals can also be affected. When angioedema strikes the intestines, it can cause abdominal swelling or distention and in some cases bowel obstruction. We have heard from many patients that this condition can be hard to diagnose.

Here are some stories:

“I was put on lisinopril for high blood pressure in January. That month I experienced severe stomach cramping and vomiting. I was rolling on the floor in agony. The doctor said it was most likely the flu but started me on two different antibiotics in case it was bacterial.

“A few weeks later I had another attack with severe stomach cramping and vomiting. I went to the ER, where I was given IV pain meds. A CT scan showed small intestine inflammation partially blocking off my bowel. I was sent home but returned the next day with pain that was a 10 on a 10-point scale. The doctor said that all the tests had been done and there was nothing he could do. I was sent home with pain medication.

“A few weeks later I was admitted to the hospital with increased small intestine inflammation and another blockage. After vomiting for 12 hours, I was released four days later with no definitive diagnosis.

“The doctors said most likely I had Crohn’s disease, but a subsequent colonoscopy was negative for Crohn’s. I underwent extensive tests, including endoscopy, and all were negative. None of the doctors made a connection with the drug lisinopril.

“After two months of missing work, three more ER visits and untold suffering, I found several other people who reported similar symptoms connected to lisinopril. I stopped the medication and have not had another attack. If you look on PubMed you can see reports on lisinopril and intestinal angioedema, but doctors don’t think to connect this with lisinopril because it is not listed as a common side effect.”

Another visitor to our website responded:

“I feel your pain, trust me. This reaction to lisinopril is the worst pain I’ve ever had, worse even than labor. It was ridiculous that they did so many tests and still couldn’t figure it out for so long.

“I know doctors think this is really rare. I had to look up the exact words ‘intestinal angioedema lisinopril’ to find it online. But I think when you get a prescription you should get information on all of the side effects. My doctors were considering removing part of my intestine at one point. If only they had realized sooner that lisinopril was the cause, I wouldn’t have suffered so long.”

NG experienced anaphylaxis:

“I too have been experiencing a lot of mysterious abdominal pain after switching the brand of lisinopril I was taking. After months of abdominal attacks that came with ‘allergic type’ reactions, I finally had to go to the ER because of an anaphylactic reaction.

“I saw an allergist who listened carefully and told me that lisinopril could have caused the reaction. It has now been two days since I stopped taking it and I have no abdominal pain at all. I have not been pain free for 5 months and am so grateful for an observant doctor.”

Christie reports a lengthy ordeal:

“Yes, this drug does cause angioedema. At least you were lucky enough (considering all you dealt with) to be diagnosed and treated in a few weeks. I had angioedema in my intestine and it took over two and a half months for doctors to figure out that it was the lisinopril because it’s such a rare reaction. They couldn’t believe I didn’t have the swelling in my mouth, throat, etc. as well.

“I don’t blame the doctors because not everyone reacts to medications the same. Unfortunately you don’t know if you’re allergic until you take it. There were only 22 reports of my allergy to it from 2000 to 2010 out of 80,000+ reports of various side effects.

“I wish pharmacies put the rare reactions on the info they give you about drugs but they usually only list the ‘common’ side effects. I am glad you are better. It’s a long road to recovery. I had two surgeries and spent a month in the hospital because of this medicine.”

Other ACE Inhibitor Adverse Reactions:

ACE inhibitors can trigger other side effects besides angioedema. The most notorious is a dry, hacking cough that is uncontrollable with cough medicine. This cough can be terribly disruptive and lead to vomiting. Getting a good night’s sleep can be challenging if you are susceptible to an ACEi-induced cough.

Tommy reported the lisinopril cough and angioedema:

“I was just diagnosed with angioedema this morning. I’ve been taking 10mg of lisinopril for the past 4 years. This morning I woke up with a VERY swollen bottom lip. Scary stuff. I was lucky it was only the lip.

“Then I heard that lisinopril can also cause a bad cough. For the past 4 years I’ve had a bad, unrelenting cough that no one seems to be able to figure out. Then I read about this. I am now on another non-ACE drug. I hope that is what caused the cough because it’s bad enough to make you think about ending it all. NO MORE ACEi drugs for me!”

Linda shared a tragic story about the lisinopril cough:

“My mother-in-law was nearly 90 years and fragile when she went to a nursing home. While there she was prescribed lisinopril as one of her new medications.

“She developed the classic dry cough and coughed day and night. Her little body folded up and hurt with each cough. On my visits from many states away I noticed especially her stomach muscles and ribs were taking a pounding. It was thought she ‘would get used to it.’ Her caring family put their faith in the doctor’s advice.

“She eventually cracked some ribs from the cough, fell off her wheel chair and broke her hip, had hip surgery and died a few weeks later. It was heartbreaking to imagine all the mistakes the lovely lady endured: mistakes by the facility, as well those choices made in trust by those who were her agents for health care. So much unnecessary pain and sorrow – and for what reason I’d like to know.”

Chris had a hard time accepting that he was in trouble:

“I was on lisinopril for 5 years, and although it lowered my BP very effectively, I had a ‘deal with it’ attitude regarding the dry cough side effect and random tingling in my extremities. About 2 weeks ago, I started waking up at night with torrential mucus in my throat, making it hard to breathe. I was wheezing and had trouble swallowin. My neck hurt, and I felt something was really wrong.

“I stopped taking lisinopril right away, and on the 4th day my neck pain finally went away, and I no longer felt like I had a swollen throat. Typical guy, I should’ve gone to the ER. Because I could not get an appointment with my doctor quickly, my BP shot up to 155/100. Not believing the throat problem was related to the drug, I took one lisinopril last night.

“Within 30 minutes, same thing happened, but it was worse this time!! I apparently am officially allergic to lisinopril. Be careful, folks. I didn’t expect this after taking the drug for 5 years without a reaction. I didn’t believe it either. But my run with lisinopril is officially over.”

Protect Yourself From Coughs & Angioedema!

To our great dismay, many health professionals seemingly have a hard time diagnosing an ACE inhibitor cough or abdominal angioedema. Angioedema is especially worrisome because if affects the mouth and throat it can become a life-threatening emergency. Abdominal angioedema may be dismissed as bloating, indigestion or some other digestive tract problem. But if there is a blockage within the gastrointestinal system, the pain can be unbearable and the consequences quite dire.

You will find many details about the proper technique for measuring your blood pressure, the best home monitors and some nondrug options for managing blood pressure in our eGuide to Blood Pressure Solutions. You will find it under the Health eGuides tab at this website.

Share your own ACE inhibitor story (positive as well as negative) below in the comment section. Just click on the “View Comments” tab. If you know someone taking an ACE inhibitor such as lisinopril, please pass this article along.