Lisinopril side effects cough
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Lisinopril-Induced Cough: Incidence and Gender Differences
Introduction to Lisinopril and Cough
Lisinopril, an angiotensin-converting enzyme (ACE) inhibitor, is widely used to treat hypertension and heart failure. However, a common and troublesome side effect associated with ACE inhibitors, including lisinopril, is a persistent dry cough. This article synthesizes research findings on the incidence of lisinopril-induced cough and explores gender differences in its occurrence.
Incidence of Lisinopril-Induced Cough
Several studies have documented the incidence of cough among patients treated with lisinopril. In a multicenter study, 8.5% of patients on lisinopril reported experiencing a cough, compared to only 3.1% of those on nifedipine. Another study found that 60% of patients on lisinopril experienced a cough, significantly higher than the 15.6% on telmisartan and 9.7% on placebo. Similarly, a study comparing lisinopril with valsartan and hydrochlorothiazide reported a 68.9% incidence of cough in the lisinopril group, much higher than the 19.5% in the valsartan group.
Gender Differences in Lisinopril-Induced Cough
Research indicates a notable gender disparity in the incidence of lisinopril-induced cough. Women are significantly more likely to report this side effect than men. In one study, 12.6% of women on lisinopril reported a cough compared to 4.4% of men . This gender difference was consistent across various methods of reporting, including spontaneous reports and specific questioning . Another study corroborated these findings, showing a higher incidence of cough in women (79%) compared to men (56%).
Comparison with Other ACE Inhibitors and Alternatives
Lisinopril's propensity to cause cough is not unique among ACE inhibitors. Other ACE inhibitors like enalapril and captopril also have high incidences of cough, though some studies suggest that lisinopril may have a slightly lower incidence compared to these alternatives . Angiotensin II receptor antagonists, such as losartan and valsartan, have been shown to cause significantly fewer instances of cough compared to lisinopril, making them viable alternatives for patients who develop this side effect .
Mechanism Behind ACE Inhibitor-Induced Cough
The exact mechanism behind 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 dry cough. This mechanism is supported by the observation that nonsteroidal anti-inflammatory drugs, which inhibit prostaglandin synthesis, can alleviate the cough in some patients.
Conclusion
Lisinopril-induced cough is a common side effect, with a higher incidence observed in women compared to men. While the exact mechanism remains unclear, the accumulation of bradykinin and substance P is a likely contributor. For patients who experience this side effect, switching to an angiotensin II receptor antagonist like losartan or valsartan may provide relief. Understanding these nuances can help healthcare providers better manage and mitigate this side effect in their patients.
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