Blood Pressure Drugs That Cause Coughing

Introduction to ACE Inhibitors and Cough

Angiotensin-converting enzyme (ACE) inhibitors are commonly prescribed for managing hypertension. However, a notable side effect associated with ACE inhibitors is a persistent dry cough, which can affect patient compliance and quality of life .

Comparative Studies on ACE Inhibitors

Imidapril vs. Enalapril

A comparative study involving 489 patients with essential or renal parenchymal hypertension revealed that the incidence of cough was significantly higher in patients treated with enalapril compared to those treated with imidapril. Specifically, 38.6% of patients on enalapril experienced cough, whereas only 15.2% of those on imidapril did. This suggests that while both drugs are effective in lowering blood pressure, imidapril may be better tolerated in terms of cough.

Eprosartan vs. Enalapril

Another study compared the effects of eprosartan, an angiotensin receptor blocker (ARB), with enalapril in 528 hypertensive patients. The results showed that enalapril was associated with a 3.45-fold higher risk of developing a persistent dry cough compared to eprosartan . This indicates that ARBs like eprosartan may be preferable for patients who experience cough with ACE inhibitors.

Losartan and Cough

Losartan vs. Enalapril

A study comparing losartan, an ARB, with enalapril found that losartan did not increase the incidence of dry cough, unlike enalapril. The incidence of dry cough was significantly lower in the losartan group (1.0% to 3.0%) compared to the enalapril group (12.2% to 15.1%). This further supports the use of ARBs as an alternative to ACE inhibitors for patients who develop cough.

Rare Cases of Losartan-Induced Cough

Although rare, there have been isolated reports of losartan causing dry, irritating cough. One case study described a 49-year-old woman who developed a severe dry cough eight weeks after starting losartan, which resolved after discontinuing the drug. This suggests that while ARBs generally have a lower incidence of cough, they are not entirely free from this side effect.

Mechanism Behind ACE Inhibitor-Induced Cough

The cough associated with ACE inhibitors is believed to be due to the accumulation of bradykinin, substance P, and prostaglandins in the lungs. These substances are normally degraded by ACE, and their accumulation can lead to irritation and cough . This mechanism is not shared by ARBs, which explains their lower incidence of cough.

Systematic Reviews and Meta-Analyses

A systematic review comparing ACE inhibitors and ARBs concluded that both classes of drugs are equally effective in lowering blood pressure. However, ACE inhibitors are more likely to cause cough, with an estimated incidence ranging from 5% to 20%. Another meta-analysis of 354 randomized trials confirmed that while ACE inhibitors are effective, they are associated with a higher prevalence of cough compared to ARBs.

Conclusion

ACE inhibitors are effective antihypertensive agents but are commonly associated with a persistent dry cough. Comparative studies and systematic reviews consistently show that ARBs, such as losartan and eprosartan, are associated with a significantly lower incidence of cough. Therefore, ARBs may be a better option for patients who experience this side effect with ACE inhibitors.

Blood pressure drugs that cause coughing

Summary

Not a yes or no question