Blood pressure medication cough
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These studies suggest that ARBs like eprosartan, losartan, and irbesartan are associated with less cough compared to ACE inhibitors like enalapril, which is effective in lowering blood pressure but more likely to cause coughing.
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Blood Pressure Medication and Cough: A Comparative Analysis
Introduction to Blood Pressure Medications and Cough
Blood pressure medications, particularly those targeting the renin-angiotensin system, are effective in managing hypertension. However, some of these medications are associated with adverse effects, such as cough. This article synthesizes research findings on the incidence of cough among different blood pressure medications, focusing on angiotensin-converting enzyme inhibitors (ACE inhibitors) and angiotensin II receptor blockers (ARBs).
ACE Inhibitors and Cough
Incidence of Cough with ACE Inhibitors
ACE inhibitors, such as enalapril, are commonly prescribed for hypertension but are frequently associated with a persistent, dry cough. Studies have shown that the incidence of cough with enalapril can be significant. For instance, a study comparing enalapril and eprosartan found that enalapril was associated with a 3.45-fold higher risk of definite cough compared to eprosartan (14/261 vs. 4/259, P = 0.018) . Another study reported that enalapril had a cough incidence of 21.95%.
Comparative Studies of ACE Inhibitors
Different ACE inhibitors have varying incidences of cough. For example, a study comparing fosinopril and enalapril in patients with a history of ACE inhibitor-associated cough found that fosinopril was associated with less frequent cough (40.6 vs. 52.8, P = 0.02). Similarly, imidapril was associated with a significantly lower incidence of cough compared to enalapril (15.2% vs. 38.6%, P < 0.001).
ARBs as an Alternative
Lower Incidence of Cough with ARBs
ARBs, such as losartan and irbesartan, are often used as alternatives to ACE inhibitors due to their lower incidence of cough. A study comparing losartan and enalapril found that losartan did not increase the incidence of dry coughing, whereas enalapril did (1.0% vs. 12.2% at week 12). Another study reported that irbesartan had a significantly lower incidence of cough compared to enalapril (2.5% vs. 13.1%, P = 0.007).
Systematic Reviews and Meta-Analyses
Systematic reviews have confirmed that ARBs are associated with fewer adverse effects, including cough, compared to ACE inhibitors. One review highlighted that while both ACE inhibitors and ARBs are effective in lowering blood pressure, ACE inhibitors are more likely to cause cough. Another meta-analysis found that ARBs caused no excess of symptoms, including cough, compared to ACE inhibitors.
Conclusion
In summary, while ACE inhibitors are effective in managing hypertension, they are often associated with a higher incidence of cough. ARBs, on the other hand, provide a comparable blood pressure-lowering effect with a significantly lower risk of cough. For patients who experience cough with ACE inhibitors, switching to an ARB may be a beneficial alternative. This evidence supports the consideration of ARBs as a first-line treatment for hypertension, particularly in patients prone to cough.
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