Blood pressure medications and cough
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Blood Pressure Medications and Cough: Key Drug Classes
ACE Inhibitors and Cough Risk
Angiotensin-converting enzyme inhibitors (ACE inhibitors), such as enalapril and ramipril, are widely used to treat hypertension but are well known for causing a persistent dry cough in some patients. Studies show that up to 20% of people may discontinue ACE inhibitors due to this side effect, making cough the most common reason for stopping these medications . The cough is typically dry and persistent, and its development is linked to increased sensitivity of the cough reflex in affected individuals . Genetic factors may also play a role in who develops this cough, but more research is needed to clarify this connection .
Angiotensin Receptor Blockers (ARBs) as Alternatives
Angiotensin receptor blockers (ARBs), such as eprosartan and losartan, are another class of blood pressure medications. Multiple studies have found that ARBs are much less likely to cause cough compared to ACE inhibitors. For example, in direct comparisons, patients taking enalapril had a significantly higher risk of developing a persistent dry cough than those taking eprosartan or losartan 1235. The incidence of cough with ARBs is generally similar to placebo, making them a preferred option for patients who experience cough with ACE inhibitors 35.
Blood Pressure Control and Cough Incidence
Both ACE inhibitors and ARBs are effective at lowering blood pressure. Studies show that while both drug classes reduce blood pressure significantly, ARBs like eprosartan and losartan provide similar or slightly better blood pressure control with a lower risk of cough 1235. Interestingly, patients who develop cough on ACE inhibitors may actually experience a greater reduction in blood pressure compared to those who do not develop cough, possibly due to the role of bradykinin in both blood pressure lowering and cough development .
Other Blood Pressure Medications
Other classes of blood pressure medications, such as calcium channel blockers (e.g., amlodipine), are not commonly associated with cough. For example, a case study of a patient on amlodipine did not link her chronic cough to the medication, highlighting that cough is not a typical side effect of this drug class .
Newer Therapies and Cough Risk
Newer blood pressure medications, such as LCZ696 (a combination of an ARB and a neprilysin inhibitor), have been shown to lower blood pressure more effectively than ARBs alone. However, LCZ696 may increase the risk of cough compared to ARBs, though the risk is still lower than with ACE inhibitors .
Conclusion
ACE inhibitors are effective for blood pressure control but are frequently associated with a persistent dry cough, leading many patients to discontinue therapy. ARBs offer similar blood pressure-lowering benefits with a much lower risk of cough and are often recommended for patients who cannot tolerate ACE inhibitors due to this side effect. Other blood pressure medications, such as calcium channel blockers, are not typically linked to cough. When choosing a blood pressure medication, the risk of cough should be considered, especially for patients who have experienced this side effect in the past.
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