Does arbs cause cough
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Summary
10 papers analyzed
These studies suggest ARBs cause fewer cough events compared to ACE inhibitors.
Consensus Meter
6 papers analyzed
Yes - 17%
Possibly - 0%
No - 83%
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Beta20 papers analyzed
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 ARBs vs. ACE Inhibitors
Lower Cough Incidence with ARBs
Multiple studies have consistently shown that ARBs are associated with a significantly lower incidence of cough compared to ACE inhibitors. A systematic review and meta-analysis found that ARBs had fewer cough events compared to ACE inhibitors, with a risk ratio (RR) of 0.37 (95% CI 0.28, 0.48) . This indicates that patients on ARBs are less likely to experience cough than those on ACE inhibitors.
Similar Cough Incidence to Placebo
Further supporting the tolerability of ARBs, research has demonstrated that the incidence of cough with ARBs is similar to that with placebo. The same meta-analysis reported that the risk of cough with ARBs was comparable to placebo (RR 1.01; 95% CI 0.74, 1.39) . This suggests that ARBs do not significantly increase the risk of cough beyond what is observed with no active treatment.
Pediatric Considerations
In pediatric populations, the incidence of cough with ARBs is also low. An analysis of randomized trials for pediatric hypertension treatment found that the reported incidence of cough in children receiving ARBs was 1.8%, which was not significantly different from the 3.2% incidence in children receiving ACE inhibitors (P = 0.34). This indicates that ARBs are a viable option for children who require antihypertensive therapy without the added risk of cough.
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 the risk ratio of reporting cough was significantly elevated in trials using ACE inhibitors as comparators (RR 20.77; 95% CI 7.47 to 57.76). This suggests that the perceived incidence of cough with ARBs might be influenced by the high incidence of cough associated with ACE inhibitors.
Conclusion
In summary, ARBs are associated with a significantly lower incidence of cough compared to ACE inhibitors and have a cough incidence similar to placebo. This makes ARBs a preferable option for patients who experience cough with ACE inhibitors. The findings are consistent across adult and pediatric populations, reinforcing the safety profile of ARBs in terms of cough. Therefore, ARBs can be considered a suitable alternative for patients intolerant to ACE inhibitors due to cough.
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