High blood pressure medicine cough
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These studies suggest that ACE inhibitors effectively lower blood pressure but are more likely to cause coughing compared to ARBs, which also effectively reduce blood pressure with fewer instances of cough.
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High Blood Pressure Medicine and Cough: A Comparative Analysis
Introduction to High Blood Pressure Medications
High blood pressure, or hypertension, is a prevalent condition that requires effective management to prevent serious health complications. Among the various classes of antihypertensive medications, Angiotensin-Converting Enzyme (ACE) inhibitors and Angiotensin II Receptor Blockers (ARBs) are commonly prescribed. However, a notable side effect associated with ACE inhibitors is the development of a persistent cough. This article explores the incidence of cough in patients using different high blood pressure medications and compares the efficacy and side effects of ACE inhibitors and ARBs.
ACE Inhibitors and Cough
Incidence of Cough with ACE Inhibitors
ACE inhibitors, such as ramipril and enalapril, are effective in lowering blood pressure but are frequently associated with a higher incidence of cough. In the PHARAO study, ramipril was found to significantly reduce the progression to manifest hypertension in patients with high-normal blood pressure. However, the incidence of cough was notably higher in the ramipril group (4.8%) compared to the control group (0.4%). Similarly, a study comparing enalapril and eprosartan reported a 3.45-fold higher risk of definite cough with enalapril (14/261) compared to eprosartan (4/259) .
Comparative Studies on ACE Inhibitors and ARBs
A systematic review comparing ACE inhibitors and ARBs found that both classes of drugs have similar long-term effects on blood pressure. However, ACE inhibitors were consistently associated with a higher frequency of cough compared to ARBs. Another study comparing losartan (an ARB) with enalapril demonstrated that losartan did not increase the incidence of dry cough, whereas enalapril did, with a significant difference in the incidence of dry coughing between the two groups (1.0% for losartan vs. 12.2% for enalapril).
ARBs as an Alternative
Efficacy and Tolerability of ARBs
ARBs, such as eprosartan and losartan, are shown to be effective in lowering blood pressure with a lower incidence of cough. In a 26-week study, eprosartan was associated with a significantly lower overall incidence of cough compared to enalapril, while both medications effectively reduced blood pressure . Additionally, the combination of telmisartan (an ARB) and ramipril did not show an increase in benefit but was associated with more adverse events, suggesting that ARBs alone might be a preferable option for patients prone to cough.
Safety Profile of ARBs
The safety profile of ARBs is generally favorable, with fewer incidences of cough and other adverse effects compared to ACE inhibitors. For instance, telmisartan was found to have a lower rate of cough (1.1%) compared to ramipril (4.2%) in patients with vascular disease or high-risk diabetes. This makes ARBs a suitable alternative for patients who experience cough with ACE inhibitors.
Conclusion
In summary, while both ACE inhibitors and ARBs are effective in managing high blood pressure, ACE inhibitors are more likely to cause a persistent cough. ARBs, on the other hand, offer a similar efficacy in blood pressure reduction with a significantly lower risk of cough, making them a preferable option for patients who experience this side effect. Clinicians should consider these differences when prescribing antihypertensive medications to optimize patient outcomes and adherence to treatment.
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