Coughing side effect of lisinopril
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Coughing Side Effect of Lisinopril: An Overview
Introduction to Lisinopril and Cough
Lisinopril, an angiotensin-converting enzyme (ACE) inhibitor, is widely used to treat hypertension and heart failure. However, a common and troublesome side effect associated with ACE inhibitors, including lisinopril, is a persistent dry cough. This article synthesizes findings from multiple studies to provide a comprehensive understanding of the incidence, gender differences, and comparative analysis of lisinopril-induced cough.
Incidence of Lisinopril-Induced Cough
Several studies have documented the incidence of cough in patients treated with lisinopril. In a multicenter study, 8.5% of patients on lisinopril reported experiencing a cough, compared to 3.1% of those on nifedipine . Another study found that 60% of patients on lisinopril experienced a cough, significantly higher than the 15.6% on telmisartan and 9.7% on placebo. Similarly, a study comparing lisinopril with valsartan and hydrochlorothiazide reported a 68.9% incidence of cough in the lisinopril group, much higher than the 19.5% in the valsartan group.
Gender Differences in Lisinopril-Induced Cough
Research indicates a notable gender disparity in the incidence of lisinopril-induced cough. Women are significantly more likely to report this side effect than men. In one study, 12.6% of women on lisinopril reported a cough compared to 4.4% of men . This gender difference was consistent across various studies, suggesting that women are more susceptible to this side effect.
Comparison with Other Antihypertensive Agents
Comparative studies have shown that the incidence of cough is higher with lisinopril than with other antihypertensive agents. For instance, the incidence of cough with losartan, an angiotensin II receptor antagonist, was significantly lower (29%) compared to lisinopril (72%) . Similarly, valsartan and hydrochlorothiazide were associated with a lower incidence of cough compared to lisinopril.
Mechanism Behind Lisinopril-Induced Cough
The exact mechanism behind ACE inhibitor-induced cough is not fully understood, but it is believed to involve the accumulation of bradykinin and substance P, which are normally degraded by ACE. These substances can stimulate lung afferent C fibers, leading to a persistent dry cough. The role of prostaglandins has also been suggested, as nonsteroidal anti-inflammatory drugs (NSAIDs) have been reported to alleviate the cough in some cases.
Conclusion
Lisinopril-induced cough is a common side effect, with a higher incidence in women and significantly more frequent than with other antihypertensive agents like telmisartan, valsartan, and losartan. Understanding the incidence, gender differences, and comparative data can help healthcare providers make informed decisions when prescribing ACE inhibitors and managing their side effects.
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