Lisinopril and dry cough
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Lisinopril and Dry Cough: An Overview
Introduction to Lisinopril and Dry Cough
Lisinopril, an angiotensin-converting enzyme (ACE) inhibitor, is widely used for treating hypertension and heart failure. However, a common side effect associated with ACE inhibitors, including lisinopril, is a persistent dry cough. This article synthesizes research findings on the incidence and mechanisms of lisinopril-induced dry cough and compares it with other antihypertensive agents.
Incidence of Dry Cough with Lisinopril
Several studies have documented the high incidence of dry cough in patients treated with lisinopril. In a multicenter, randomized, double-blind study, 60% of patients on lisinopril reported experiencing a dry cough, significantly higher than those on telmisartan (15.6%) or placebo (9.7%). Another study found that 68.9% of patients on lisinopril developed a dry cough compared to 19.5% on valsartan and 19.0% on hydrochlorothiazide. These findings consistently show that lisinopril is associated with a higher incidence of dry cough compared to other antihypertensive agents.
Mechanisms Behind Lisinopril-Induced Cough
The exact mechanism of 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 dry, tickling cough . Additionally, prostaglandins may play a role, as indicated by studies showing that pretreatment with indomethacin, a prostaglandin synthesis inhibitor, reduces the incidence of cough.
Comparison with Angiotensin II Receptor Antagonists
Angiotensin II receptor antagonists (ARBs), such as losartan and telmisartan, have been shown to cause significantly fewer instances of dry cough compared to ACE inhibitors. In a study involving patients with a history of ACE inhibitor-induced cough, only 29% of those treated with losartan reported a cough, compared to 72% of those on lisinopril. Another study confirmed that the incidence of dry cough with losartan (36.7%) was comparable to placebo (31.4%) and significantly lower than with lisinopril (87.5%).
Clinical Implications
Given the high incidence of dry cough associated with lisinopril, clinicians may consider prescribing ARBs as an alternative for patients who develop this side effect. ARBs like losartan and telmisartan offer similar antihypertensive efficacy without the high risk of cough . This switch can improve patient compliance and overall treatment satisfaction.
Conclusion
Lisinopril is effective for managing hypertension and heart failure but is frequently associated with a troublesome dry cough. This side effect is significantly less common with ARBs, making them a preferable option for patients who experience ACE inhibitor-induced cough. Understanding the mechanisms and incidence of this side effect can help healthcare providers make informed decisions to optimize patient care.
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