Does lisinopril cause coughing
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Lisinopril and Cough: Analyzing the Evidence
Introduction to Lisinopril and Cough
Lisinopril, an angiotensin-converting enzyme (ACE) inhibitor, is widely used to treat hypertension and heart failure. However, a common side effect associated with ACE inhibitors, including lisinopril, is a persistent dry cough. This article synthesizes findings from multiple studies to understand the incidence and mechanisms of lisinopril-induced cough.
Incidence of Cough with Lisinopril
Several studies have consistently shown that lisinopril is associated with a significantly higher incidence of cough compared to other antihypertensive agents. In a multicenter, randomized, double-blind study, 60% of patients treated with lisinopril reported experiencing a dry cough, compared to only 15.6% of those treated with telmisartan, an angiotensin II receptor antagonist, and 9.7% of those given a placebo. Another study found that 72% of patients on lisinopril experienced cough, a much higher rate than the 29% observed with losartan and 34% with hydrochlorothiazide .
Comparison with Other Antihypertensive Agents
The incidence of cough with lisinopril is notably higher than with other antihypertensive medications. For instance, losartan, another antihypertensive agent, was associated with a significantly lower incidence of cough (29%) compared to lisinopril (72%) . Similarly, valsartan, another angiotensin II receptor antagonist, resulted in a lower incidence of cough (19.5%) compared to lisinopril (68.9%). These findings suggest that angiotensin II receptor antagonists like losartan and valsartan are preferable for patients who develop a cough with ACE inhibitors.
Mechanisms Behind Lisinopril-Induced Cough
The mechanism behind lisinopril-induced cough is believed to be related to the accumulation of bradykinin and substance P, which are not broken down due to the inhibition of kininase II by ACE inhibitors. This accumulation can lead to increased sensitivity of the cough reflex. Studies in rabbits have shown that lisinopril increases the cough response induced by both mechanical and chemical stimulation, whereas losartan does not . This supports the hypothesis that the cough is mediated by the central accumulation of bradykinin and substance P.
Gender Differences in Cough Incidence
Interestingly, there appears to be a gender difference in the incidence of lisinopril-induced cough. Women are more likely to report a cough than men. In one study, 12.6% of women treated with lisinopril reported a cough compared to 4.4% of men. This suggests that female patients may be more susceptible to this side effect.
Conclusion
Lisinopril is associated with a significantly higher incidence of cough compared to other antihypertensive agents such as losartan and valsartan. The cough is likely due to the accumulation of bradykinin and substance P, which increases the sensitivity of the cough reflex. Patients, especially women, who develop a cough with lisinopril may benefit from switching to an angiotensin II receptor antagonist. This evidence highlights the importance of personalized treatment plans in managing hypertension effectively.
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