Blood Pressure Medication That Causes Cough

Introduction to ACE Inhibitors and Cough

Angiotensin-converting enzyme inhibitors (ACE inhibitors) are commonly prescribed medications for managing hypertension. However, a notable side effect associated with ACE inhibitors is the development of a persistent dry cough. This article explores the incidence and mechanisms of cough induced by ACE inhibitors, comparing them with other antihypertensive agents.

Incidence of Cough with ACE Inhibitors

Enalapril and Ramipril

Studies have shown that both enalapril and ramipril can significantly increase the sensitivity of the cough reflex in patients who develop a cough during treatment. In a controlled study, three out of twenty patients reported cough symptoms when treated with either enalapril or ramipril, while no cough was reported with placebo. This suggests a direct correlation between these ACE inhibitors and the development of cough.

Comparative Studies with Other ACE Inhibitors

A randomized study comparing the incidence of cough among different ACE inhibitors found that enalapril had a higher incidence of cough (21.95%) compared to cilazapril (22.86%), perindopril (10.96%), and imidapril (13.16%). This indicates variability in cough incidence among different ACE inhibitors, with enalapril being one of the more likely to cause this side effect.

Comparison with Angiotensin II Receptor Blockers (ARBs)

Eprosartan vs. Enalapril

In a double-blind study comparing eprosartan, an angiotensin receptor blocker (ARB), with enalapril, it was found that enalapril was associated with a significantly higher risk of cough. Specifically, enalapril treatment resulted in a 3.45-fold higher risk of definite cough compared to eprosartan . This suggests that ARBs like eprosartan may be preferable for patients who experience cough with ACE inhibitors.

Losartan vs. Enalapril

Another study comparing losartan (an ARB) with enalapril demonstrated that losartan did not increase the incidence of dry cough, whereas enalapril did. The incidence of dry cough was significantly higher in the enalapril group (15.1%) compared to the losartan group (3.0%). This further supports the notion that ARBs are less likely to cause cough compared to ACE inhibitors.

Mechanisms Behind ACE Inhibitor-Induced Cough

The development of cough with ACE inhibitors is believed to be related to the accumulation of bradykinin and substance P, which are not adequately broken down due to the inhibition of the angiotensin-converting enzyme. This accumulation can lead to increased sensitivity of the cough reflex and the development of a persistent dry cough .

Conclusion

ACE inhibitors, while effective in managing hypertension, are associated with a higher incidence of cough compared to ARBs. Enalapril, in particular, has been shown to cause cough more frequently than other ACE inhibitors and ARBs like eprosartan and losartan. For patients who develop a persistent dry cough with ACE inhibitors, switching to an ARB may be a viable alternative to mitigate this side effect.

Blood pressure medication that causes cough

Summary

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