Lisinopril cough phlegm
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Lisinopril-Induced Cough and Phlegm: A Comparative Analysis
Introduction to Lisinopril and Cough
Lisinopril, an angiotensin-converting enzyme (ACE) inhibitor, is commonly prescribed for hypertension and heart failure. However, a notable side effect of lisinopril is the development of a dry, persistent cough. This cough can be particularly troublesome for patients, often leading to discontinuation of the medication.
Incidence of Cough with Lisinopril
Several studies have documented the high incidence of cough associated with lisinopril. In a study comparing lisinopril with losartan and hydrochlorothiazide, it was found that the percentage of patients who complained of cough was significantly higher with lisinopril (72%) compared to losartan (29%) and hydrochlorothiazide (34%) . Another study reported that 68.9% of patients on lisinopril experienced a dry, persistent cough, which was significantly higher than the 19.5% incidence with valsartan and 19.0% with hydrochlorothiazide.
Gender Differences in Lisinopril-Induced Cough
Interestingly, there appears to be a gender disparity in the incidence of lisinopril-induced cough. Women treated with lisinopril reported cough three times more often than men (12.6% vs. 4.4%). This suggests that female patients may be more susceptible to this side effect.
Comparison with Other Antihypertensive Agents
Losartan and Valsartan
Losartan and valsartan, both angiotensin II receptor antagonists, have been shown to cause significantly fewer instances of cough compared to lisinopril. In multiple studies, the incidence of cough with losartan was found to be similar to that of placebo and significantly lower than with lisinopril . Similarly, valsartan was associated with a much lower incidence of cough (19.5%) compared to lisinopril (68.9%).
Telmisartan
Telmisartan, another angiotensin II receptor antagonist, also demonstrated a lower incidence of cough (15.6%) compared to lisinopril (60%) and was comparable to placebo (9.7%). This further supports the notion that angiotensin II receptor antagonists are preferable for patients who develop a cough with ACE inhibitors.
Mechanism Behind Lisinopril-Induced Cough
The cough associated with lisinopril is believed to be related to the inhibition of kininase II, an enzyme that degrades bradykinin and substance P. The accumulation of these peptides in the respiratory tract can lead to a persistent cough. This mechanism is less pronounced with angiotensin II receptor antagonists, which may explain the lower incidence of cough with these medications.
Conclusion
Lisinopril is associated with a high incidence of dry, persistent cough, particularly in female patients. Angiotensin II receptor antagonists such as losartan, valsartan, and telmisartan offer effective alternatives with significantly lower incidences of cough. For patients who experience lisinopril-induced cough, switching to these alternatives can provide relief while maintaining antihypertensive efficacy.
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