Ace inhibitor cough
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Summary
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Some studies suggest ACE inhibitors can cause chronic cough and stopping the medication is the most effective treatment, while other studies indicate that factors like age, gender, and concomitant medications may influence the incidence of cough.
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ACE Inhibitor-Induced Cough: Incidence, Mechanisms, and Management
Incidence of ACE Inhibitor-Induced Cough
Angiotensin-converting enzyme (ACE) inhibitors are widely used for managing cardiovascular diseases, but they are often associated with a persistent, dry cough. The incidence of this side effect varies significantly across studies, ranging from 5% to 35% of patients treated with ACE inhibitors . Meta-analyses of randomized controlled trials (RCTs) have shown that the risk of developing a cough is significantly higher in patients on ACE inhibitors compared to those on placebo, with a relative risk (RR) of 2.66. However, the actual incidence of cough leading to discontinuation of therapy is lower, around 3.9%.
Mechanisms Behind ACE Inhibitor-Induced Cough
The exact mechanism of ACE inhibitor-induced cough is not fully understood, but it is believed to involve the accumulation of protussive mediators such as bradykinin and substance P. These substances are normally degraded by ACE, and their accumulation in the respiratory tract can trigger a cough reflex . Additionally, the inhibition of kininase II activity may lead to increased levels of prostaglandins, further contributing to the cough .
Risk Factors and Demographic Variations
Certain demographic factors can influence the likelihood of developing a cough from ACE inhibitors. Women are generally at a higher risk compared to men, with studies showing a higher incidence of cough in female patients . Older age and the concomitant use of lipid-lowering agents are also significant predictors of ACE inhibitor-induced cough. However, racial background does not appear to significantly affect the incidence of this side effect.
Management and Treatment Options
The only uniformly effective treatment for ACE inhibitor-induced cough is the cessation of the offending agent . In most cases, the cough resolves within 1 to 4 weeks after discontinuation, although it can persist for up to 3 months in some patients. Switching to angiotensin-receptor blockers (ARBs) is often recommended, as they have a much lower incidence of cough. Pharmacologic agents such as nonsteroidal anti-inflammatory drugs (NSAIDs) have been shown to attenuate the cough in some cases, but their use is not universally recommended .
Conclusion
ACE inhibitor-induced cough is a common and often bothersome side effect that can significantly impact patient compliance. Understanding the incidence, mechanisms, and risk factors associated with this adverse effect can help healthcare providers make informed decisions about patient management. While cessation of the ACE inhibitor is the most effective treatment, alternative therapies such as ARBs can offer relief for patients who require ongoing cardiovascular treatment.
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