Can Lisinopril Cause A Cough

Can Lisinopril Cause a Cough?

Introduction to Lisinopril and Cough

Lisinopril, an angiotensin-converting enzyme (ACE) inhibitor, is commonly prescribed for managing hypertension and heart failure. However, a notable side effect associated with ACE inhibitors, including lisinopril, is the development of a persistent dry cough. This article synthesizes findings from multiple studies to explore the incidence and mechanisms of lisinopril-induced cough.

Incidence of Lisinopril-Induced Cough

Several studies have consistently reported a higher incidence of cough in patients treated with lisinopril compared to other antihypertensive agents. In a multicenter, randomized, double-blind study, 72% of patients with a history of ACE inhibitor-related cough experienced a cough when treated with lisinopril, compared to 29% with losartan and 34% with hydrochlorothiazide . Another study found that 60% of patients on lisinopril reported a cough, significantly higher than the 15.6% on telmisartan and 9.7% on placebo. These findings highlight that lisinopril is more likely to induce cough compared to other antihypertensive medications.

Gender Differences in Cough Incidence

Interestingly, the incidence of lisinopril-induced cough appears to be higher in women than in men. One study reported that 12.6% of women treated with lisinopril spontaneously reported a cough, compared to only 4.4% of men. This gender disparity suggests that women may be more susceptible to this side effect.

Mechanisms Behind Lisinopril-Induced Cough

The exact mechanism of lisinopril-induced cough is not fully understood, but it is believed to be related to the accumulation of bradykinin and substance P, which are normally degraded by ACE. Lisinopril inhibits this degradation, leading to increased levels of these peptides, which can stimulate cough reflexes . Studies involving animal models have shown that lisinopril increases the cough response to both mechanical and chemical stimulation, supporting the role of bradykinin and substance P in this side effect .

Comparison with Other Antihypertensive Agents

ACE inhibitors like lisinopril are more likely to cause cough compared to angiotensin II receptor antagonists (ARBs) such as losartan and valsartan. Multiple studies have demonstrated that ARBs have a significantly lower incidence of cough, making them a preferable alternative for patients who develop a cough with ACE inhibitors . For instance, the incidence of cough with valsartan was 19.5%, significantly lower than the 68.9% observed with lisinopril.

Conclusion

Lisinopril is associated with a higher incidence of cough compared to other antihypertensive agents, particularly ARBs. This side effect is more prevalent in women and is likely due to the accumulation of bradykinin and substance P. For patients who develop a cough with lisinopril, switching to an ARB like losartan or valsartan may be a suitable alternative. Understanding these differences can help healthcare providers make informed decisions to improve patient comfort and adherence to hypertension treatment.

Summary

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