Lisinopril dry cough
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Summary
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These studies suggest that lisinopril is associated with a high incidence of dry cough, which is less common with angiotensin II receptor antagonists like telmisartan, valsartan, and losartan.
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Lisinopril and Dry Cough: Incidence and Comparisons with Other Antihypertensive Agents
Introduction to Lisinopril-Induced Dry Cough
Lisinopril, an angiotensin-converting enzyme (ACE) inhibitor, is widely used for managing hypertension and heart failure. However, a common adverse effect associated with ACE inhibitors, including lisinopril, is a persistent dry cough. This side effect can significantly impact patient compliance and quality of life.
Incidence of Dry Cough with Lisinopril
Several studies have documented the incidence of dry cough in patients treated with lisinopril. The frequency of this side effect varies but is notably high. For instance, one study reported that 60% of patients on lisinopril experienced a dry cough, compared to 15.6% on telmisartan and 9.7% on placebo. Another study found that 68.9% of patients on lisinopril developed a dry cough, significantly higher than the 19.5% on valsartan and 19.0% on hydrochlorothiazide. These findings highlight the substantial risk of cough associated with lisinopril.
Mechanism 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 persistent, nonproductive cough . This mechanism is supported by the observation that the cough often resolves within days to weeks after discontinuing the ACE inhibitor.
Comparisons with Angiotensin II Receptor Antagonists
Angiotensin II receptor antagonists (ARBs), such as losartan and valsartan, have been shown to cause significantly fewer instances of dry cough compared to ACE inhibitors like lisinopril. In a study comparing losartan, lisinopril, and placebo, the incidence of dry cough was 87.5% for lisinopril, 36.7% for losartan, and 31.4% for placebo. Another study found that only 29% of patients on losartan experienced a dry cough, compared to 72% on lisinopril. These results suggest that ARBs are a preferable alternative for patients who develop a cough with ACE inhibitors.
Clinical Implications and Recommendations
Given the high incidence of dry cough with lisinopril, healthcare providers should consider patient history and potential side effects when prescribing antihypertensive therapy. For patients who develop a cough with lisinopril, switching to an ARB like losartan or valsartan may provide similar therapeutic benefits with a lower risk of cough .
Conclusion
Lisinopril is associated with a high incidence of dry cough, a side effect that can significantly affect patient adherence to treatment. The mechanism likely involves the accumulation of bradykinin and substance P. Comparatively, ARBs such as losartan and valsartan present a lower risk of inducing cough, making them suitable alternatives for patients who experience this side effect with ACE inhibitors. Clinicians should be aware of these differences to optimize hypertension management and improve patient outcomes.
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