Blood pressure medicine that makes you cough

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Blood Pressure Medicine That Makes You Cough: ACE Inhibitors and Alternatives

Introduction to ACE Inhibitors and Cough

Angiotensin-converting enzyme (ACE) inhibitors are a common class of medications used to treat hypertension. However, a notable side effect of ACE inhibitors is the development of a persistent, dry cough. This side effect can significantly impact patient compliance and quality of life.

ACE Inhibitors and Cough Incidence

Several studies have documented the incidence of cough associated with ACE inhibitors. For instance, enalapril, a widely used ACE inhibitor, has been shown to increase the sensitivity of the cough reflex in patients, leading to symptomatic cough in some cases. In a comparative study, enalapril was associated with a significantly higher risk of cough compared to eprosartan, an angiotensin receptor blocker (ARB) . Another study comparing enalapril with losartan, another ARB, found that enalapril increased the incidence of dry cough, whereas losartan did not.

Mechanism Behind ACE Inhibitor-Induced Cough

The cough induced by 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 ACE enzyme. This accumulation can lead to increased sensitivity of the cough reflex and the development of a persistent cough.

Comparative Studies: ACE Inhibitors vs. ARBs

A systematic review comparing ACE inhibitors and ARBs found that while both classes of drugs are effective in lowering blood pressure, ACE inhibitors are more frequently associated with cough. This review highlighted that ARBs, such as losartan and eprosartan, do not share this side effect, making them a preferable option for patients who experience cough with ACE inhibitors.

Alternative Medications: ARBs

Given the high incidence of cough with ACE inhibitors, ARBs are often recommended as an alternative. ARBs block the angiotensin II receptor, which helps in lowering blood pressure without affecting the breakdown of bradykinin, thereby reducing the risk of cough. Studies have shown that ARBs like losartan and eprosartan are effective in managing hypertension and have a lower incidence of cough compared to ACE inhibitors .

Conclusion

ACE inhibitors are effective in managing hypertension but are commonly associated with a persistent, dry cough. This side effect is due to the accumulation of bradykinin and substance P. For patients who develop a cough with ACE inhibitors, ARBs such as losartan and eprosartan offer a viable alternative, providing similar blood pressure control without the associated cough. This makes ARBs a preferable choice for patients who are sensitive to the side effects of ACE inhibitors.