Do arbs cause cough
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Do ARBs Cause Cough?
Introduction to ARBs and ACE Inhibitors
Angiotensin receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors (ACE inhibitors) are commonly prescribed medications for managing hypertension and other cardiovascular conditions. While both classes of drugs are effective, they differ in their side effect profiles, particularly concerning the incidence of cough.
Incidence of Cough with ACE Inhibitors
ACE inhibitors are well-documented to cause cough in a significant proportion of patients, with reported incidences ranging from 5% to 20% . This side effect is attributed to the accumulation of bradykinin, a peptide that ACE inhibitors prevent from breaking down, leading to a persistent dry cough . In some populations, such as the Asian demographic, the incidence of cough leading to discontinuation of ACE inhibitors can be as high as 30.4%.
Comparative Incidence of Cough with ARBs
In contrast, ARBs do not inhibit the breakdown of bradykinin and therefore have a much lower incidence of cough. Multiple studies have shown that ARBs are associated with significantly fewer cough events compared to ACE inhibitors. For instance, a systematic review and meta-analysis found that the risk ratio (RR) of cough with ARBs was 0.37 compared to ACE inhibitors, indicating a substantially lower risk . Another meta-analysis confirmed that ARBs had a similar incidence of cough to placebo, further supporting their tolerability .
Pediatric Considerations
In pediatric patients, the incidence of cough with ARBs is also low. A study analyzing data from randomized trials for pediatric hypertension treatment found that the reported incidence of cough was 1.8% for ARBs, compared to 3.2% for ACE inhibitors, which was not statistically significant (P = 0.34).
Bias in Safety Reporting
It is important to note that the use of ACE inhibitors as comparator drugs in clinical trials may introduce bias in the reporting of adverse drug reactions (ADRs) such as cough. A meta-analysis highlighted that trials using ACE inhibitors as comparators reported a significantly higher incidence of cough in the ARB arms, suggesting potential bias in safety reporting.
Clinical Recommendations
Given the lower incidence of cough and similar efficacy in managing hypertension and other cardiovascular conditions, ARBs are often recommended as a preferable alternative to ACE inhibitors, especially for patients who have experienced cough with ACE inhibitors . This recommendation is particularly relevant for high-risk groups, such as patients with a history of angioedema or those from populations with higher incidences of ACE inhibitor-induced cough .
Conclusion
In summary, ARBs are associated with a significantly lower risk of cough compared to ACE inhibitors. This makes ARBs a suitable alternative for patients who are intolerant to ACE inhibitors due to cough. Clinicians should consider prescribing ARBs, especially for patients who have experienced adverse reactions to ACE inhibitors, to improve medication adherence and patient outcomes.
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