Cozaar (Losartan) vs Alternatives: Which Blood Pressure Medication Is Right for You?

High blood pressure affects nearly half of adults in the UK, and Losartan - sold as Cozaar - is one of the most common prescriptions to manage it. But if you’re on Cozaar and experiencing side effects, or your doctor says it’s not working well enough, you’re not alone. Many people wonder: are there better options? What else works as well - or better - than Cozaar? This guide breaks down the real differences between Losartan and its top alternatives, based on clinical evidence, patient experiences, and prescribing guidelines from the NHS and NICE.

What is Cozaar (Losartan) and how does it work?

Cozaar is the brand name for Losartan, a type of medication called an angiotensin II receptor blocker (ARB). It works by blocking a hormone called angiotensin II, which normally causes blood vessels to narrow. By blocking this effect, Losartan helps blood vessels relax, lowering blood pressure and reducing strain on the heart.

It’s typically prescribed for adults with hypertension, especially those with type 2 diabetes and kidney problems. Unlike some other blood pressure drugs, Losartan doesn’t usually cause a dry cough - a common side effect of ACE inhibitors like ramipril or lisinopril. That’s one reason many doctors start patients on it.

Standard doses range from 25mg to 100mg once daily. Most people notice a drop in blood pressure within 1-2 weeks, but full effect can take up to 4-6 weeks. It’s not a cure - it’s a long-term control tool.

Top 5 alternatives to Cozaar (Losartan)

If Cozaar isn’t working for you - whether due to side effects, cost, or insufficient blood pressure control - here are the five most commonly prescribed alternatives, each with clear pros and cons.

1. Ramipril (ACE inhibitor)

Ramipril is one of the most widely used blood pressure drugs in the UK. It belongs to the ACE inhibitor class, which works similarly to ARBs but targets a different step in the same hormonal pathway.

Pros: Proven to reduce risk of heart attack and stroke in high-risk patients. Often cheaper than Losartan. Works well for people with heart failure or diabetic kidney disease.

Cons: Up to 20% of users develop a persistent dry cough. Some report taste changes or rare swelling (angioedema). Not safe in pregnancy.

Many patients switch from ramipril to Losartan because of the cough. But if you’ve never tried ramipril and don’t mind the cough risk, it’s just as effective for lowering blood pressure.

2. Amlodipine (Calcium channel blocker)

Amlodipine is a calcium channel blocker - it relaxes the muscles in your blood vessel walls. It’s often used alone or combined with ARBs like Losartan.

Pros: Very effective, especially in older adults and Black patients. No cough risk. Works well with other meds. Usually taken once daily.

Cons: Can cause swollen ankles, flushing, or dizziness. Some people gain a little weight. Not ideal if you have severe heart failure.

NICE guidelines say amlodipine is often a better first choice than Losartan for people over 55 or of African or Caribbean descent. If you’re in that group and Cozaar hasn’t worked, amlodipine might be your next step.

3. Valsartan (another ARB)

Valsartan is another ARB, like Losartan, and is often seen as its closest competitor. Both block the same hormone, but they’re not identical.

Pros: Slightly stronger blood pressure-lowering effect in some studies. Less likely to cause dizziness than Losartan. Available as a combination pill with amlodipine or hydrochlorothiazide.

Cons: More expensive than Losartan in the UK. Some recalls in 2018-2019 due to contamination (now resolved). Slightly higher risk of high potassium levels.

Studies show Valsartan lowers systolic pressure by about 2-5mmHg more than Losartan on average. But for most people, that small difference doesn’t translate to better outcomes. It’s often chosen if Losartan causes mild side effects - not because it’s dramatically better.

4. Hydrochlorothiazide (Thiazide diuretic)

Hydrochlorothiazide (HCTZ) is a water pill. It helps your kidneys flush out extra salt and water, reducing blood volume and pressure.

Pros: Very cheap. Proven to reduce stroke risk. Often used in combination pills (like Cozaar-HCTZ). Safe for long-term use.

Cons: Can cause low potassium, dehydration, or increased urination. May raise blood sugar slightly - not ideal for diabetics. Can cause gout flare-ups.

Many doctors start with a low-dose HCTZ for mild hypertension. If that’s not enough, they add Losartan. But if you’re already on Cozaar and your pressure is still high, adding HCTZ might be better than switching.

5. Telmisartan (Another ARB with extra benefits)

Telmisartan is similar to Losartan but has a longer half-life - meaning it lasts longer in your body. It’s sometimes prescribed for once-daily dosing with more consistent 24-hour coverage.

Pros: Longer-lasting effect. May improve insulin sensitivity, which helps people with metabolic syndrome or prediabetes. Less frequent dosing.

Cons: More expensive. Limited real-world data compared to Losartan. Slightly higher risk of diarrhea.

It’s not usually a first-line choice unless you need extended coverage or have metabolic issues. But if you’re on Cozaar and forget doses often, Telmisartan might be a better fit.

Comparison table: Cozaar vs alternatives

When should you switch from Cozaar?

Not everyone needs to switch. But here are clear signs your doctor might suggest a change:

• Your blood pressure is still above 140/90 after 6-8 weeks on a full dose of Cozaar
• You have persistent dizziness or low energy that started after starting Cozaar
• Your potassium levels are too high (above 5.5 mmol/L) - a known risk with ARBs
• You’re pregnant or planning to become pregnant - ARBs are unsafe in pregnancy
• You’re over 55 or of African/Caribbean descent and Cozaar hasn’t worked well
• Cost is a barrier - and a cheaper alternative like amlodipine or ramipril would work just as well

If you’re unsure, don’t stop or change your medication on your own. Talk to your GP or pharmacist. Blood pressure control is a process - it often takes trying a few options before you find the right one.

Combination pills: Why you might not need to switch

Many people don’t realize they can stay on Cozaar and just add another drug. Combination pills like Cozaar-HCTZ (Losartan + hydrochlorothiazide) or Exforge (Losartan + amlodipine) are common in the UK.

These are often more effective than doubling the dose of one drug. They also reduce pill burden - one tablet instead of two. If your blood pressure isn’t controlled on Losartan alone, adding a second agent might be smarter than switching entirely.

What about natural alternatives?

Some people look to supplements like garlic, magnesium, or beetroot juice to lower blood pressure. While these may help slightly, they’re not replacements for prescribed medication.

For example, beetroot juice might lower systolic pressure by 4-5mmHg - helpful, but nowhere near enough if your pressure is 160/100. Lifestyle changes - weight loss, reducing salt, regular exercise - are proven to work, but they take time. Medication works fast and reliably.

Don’t stop your prescription to try a supplement. Talk to your doctor first. Some supplements can interact with blood pressure drugs - especially potassium supplements, which can be dangerous when taken with ARBs like Cozaar.

Final thoughts: Choosing the right option

There’s no single “best” blood pressure medication. What works for your neighbour might not work for you. Cozaar is a solid, safe choice - especially for diabetics or those who can’t tolerate ACE inhibitors. But it’s not the only option.

If you’re struggling with side effects, cost, or effectiveness, ask your doctor about amlodipine, ramipril, or a combination pill. These are often just as effective - and sometimes cheaper.

Remember: the goal isn’t to find the “strongest” drug. It’s to find the one that lowers your pressure safely, with minimal side effects, and that you can take every day without hassle.

Next steps if you’re considering a switch

Here’s what to do next:

1. Check your blood pressure log - are your readings consistently high?
2. Write down any side effects you’ve noticed - dizziness, swelling, fatigue, etc.
3. Ask your pharmacist if your current prescription is the cheapest option - many ARBs have cheaper generics.
4. Book a review with your GP. Bring your log and list of concerns.
5. Don’t switch on your own. Even small changes can cause dangerous drops in blood pressure.

High blood pressure is silent - but treatable. Finding the right medication takes patience, but it’s worth it. You don’t have to stay on Cozaar if it’s not working for you. There are other options. You just need to ask the right questions.