Ace inhibitors and cough
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ACE Inhibitors and Cough: An Overview
Introduction to ACE Inhibitor-Induced Cough
Angiotensin-converting enzyme (ACE) inhibitors are widely used for managing cardiovascular diseases. However, a common and often bothersome side effect of these medications is a persistent dry cough. This adverse effect has been extensively studied, revealing various insights into its incidence, mechanisms, and management.
Incidence of ACE Inhibitor-Induced Cough
The incidence of cough among patients treated with ACE inhibitors varies significantly across studies, ranging from 5% to 35% . A meta-analysis of randomized controlled trials (RCTs) reported that approximately 10% of patients on ACE inhibitors develop a cough, with about half of these patients discontinuing the medication due to this side effect . Another study found that the incidence of cough leading to discontinuation was 3.9%, with higher rates observed in women and older patients.
Mechanisms Behind ACE Inhibitor-Induced Cough
The exact mechanism of ACE inhibitor-induced cough remains unresolved, but it is believed to involve the accumulation of protussive mediators such as bradykinin and substance P. These agents are normally degraded by ACE, and their accumulation in the respiratory tract when ACE is inhibited can trigger a cough reflex . Additionally, prostaglandins, which may be stimulated by bradykinin, are also implicated in this process.
Gender Differences in ACE Inhibitor-Induced Cough
Some studies have suggested that women may experience a higher incidence of cough compared to men. However, a systematic review and meta-analysis found no significant difference in the risk ratios for developing cough between men and women. This indicates that while observational studies may show a higher incidence in women, controlled trials do not support a significant gender difference.
Placebo-Adjusted Incidence and Other Contributing Factors
A meta-analysis of placebo-controlled trials revealed that 37% of cough cases reported on ACE inhibitors could be attributed to the medication itself, while the remaining 63% could be due to other factors. This highlights the importance of considering other potential causes of cough, especially in patients with conditions like heart failure, before discontinuing ACE inhibitors.
Management of ACE Inhibitor-Induced Cough
The only uniformly effective treatment for ACE inhibitor-induced cough is the cessation of the offending agent . In most cases, the cough resolves within a few days to a few weeks after stopping the medication. Switching to another class of antihypertensive agents, such as angiotensin-receptor blockers (ARBs), which have a similar efficacy but a lower incidence of cough, is often recommended.
Conclusion
ACE inhibitor-induced cough is a common and well-documented side effect that can significantly impact patient compliance. Understanding its incidence, underlying mechanisms, and effective management strategies is crucial for healthcare providers. While the cessation of ACE inhibitors remains the primary solution, careful evaluation of other potential causes of cough is essential to avoid unnecessary discontinuation of these beneficial medications.
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