Blood pressure med that causes cough
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These studies suggest that ACE inhibitors like enalapril and ramipril can cause cough, while ARBs like losartan and eprosartan are associated with less cough.
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Blood Pressure Medications and Associated Cough: A Comparative Analysis
Introduction to ACE Inhibitors and Cough
Angiotensin-converting enzyme (ACE) inhibitors are commonly prescribed medications for managing hypertension. However, a notable side effect associated with ACE inhibitors is a persistent dry cough. This article synthesizes research findings on the incidence of cough induced by various blood pressure medications, particularly focusing on ACE inhibitors and their alternatives.
Enalapril and Ramipril: Sensitivity to Cough Reflex
Studies have shown that both enalapril and ramipril, two widely used ACE inhibitors, can significantly increase the sensitivity of the cough reflex in patients. In a controlled study, patients treated with enalapril and ramipril exhibited a higher sensitivity to capsaicin, a compound used to test cough reflex, compared to those on a placebo. Notably, three patients reported symptomatic coughs while on these medications, highlighting the potential for ACE inhibitors to induce cough in susceptible individuals.
Comparative Studies: Eprosartan vs. Enalapril
Eprosartan, an angiotensin receptor blocker (ARB), has been compared to enalapril in terms of cough incidence and blood pressure control. In a 26-week study involving 528 hypertensive patients, enalapril was associated with a significantly higher risk of persistent dry cough compared to eprosartan. Specifically, the risk of developing a definite cough was 3.45 times higher with enalapril. Despite both medications effectively lowering blood pressure, eprosartan had a slightly higher response rate and a lower incidence of cough, making it a preferable option for patients who experience cough with ACE inhibitors .
Losartan vs. Enalapril: Efficacy and Tolerability
Another ARB, losartan, has also been evaluated against enalapril. In a study with 407 patients, losartan demonstrated similar efficacy in lowering blood pressure but with a significantly lower incidence of dry cough. The incidence of cough was 12.2% in the enalapril group compared to just 1.0% in the losartan group, underscoring the advantage of ARBs over ACE inhibitors in terms of cough-related side effects.
Systematic Review: ACE Inhibitors vs. ARBs
A systematic review comparing ACE inhibitors and ARBs concluded that both classes of drugs are equally effective in managing blood pressure. However, ACE inhibitors are more likely to cause cough, with an estimated incidence ranging from 5% to 20%. This adverse effect is not commonly observed with ARBs, making them a suitable alternative for patients who develop cough with ACE inhibitors.
Genetic Factors and ACE Inhibitor-Induced Cough
The incidence of cough induced by ACE inhibitors may also be influenced by genetic factors. Research suggests that genetic variation could account for the differences in susceptibility to ACE inhibitor-induced cough among individuals. However, this area requires further investigation to fully understand the genetic predispositions involved.
Conclusion
ACE inhibitors like enalapril and ramipril are effective in controlling hypertension but are associated with a higher incidence of cough. Alternatives such as ARBs, including eprosartan and losartan, offer similar blood pressure-lowering benefits with a significantly lower risk of cough. For patients experiencing cough with ACE inhibitors, switching to an ARB may provide a more tolerable treatment option. Further research into the genetic factors influencing ACE inhibitor-induced cough could lead to more personalized hypertension management strategies.
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