Losartan and cough
Pro Research Analysisby 
Searched over 200M research papers
Consensus Meter
Losartan and Cough: A Comparative Analysis
Introduction to Losartan and ACE Inhibitor-Induced Cough
Angiotensin-converting enzyme (ACE) inhibitors are commonly prescribed for hypertension but are often associated with a persistent dry cough. This side effect can be troublesome for patients, leading to discontinuation of the medication. Losartan, an angiotensin II receptor antagonist, has been studied as an alternative to ACE inhibitors due to its potentially lower incidence of cough.
Incidence of Cough with Losartan vs. ACE Inhibitors
Clinical Trials and Findings
Multiple studies have consistently shown that losartan is associated with a significantly lower incidence of cough compared to ACE inhibitors like lisinopril. In a randomized, double-blind trial involving 135 patients with a history of ACE inhibitor-related cough, the incidence of cough was 29% for losartan, significantly lower than the 72% observed with lisinopril, and similar to the 34% with hydrochlorothiazide . Another study with 100 patients reported a cough incidence of 36.7% for losartan, compared to 87.5% for lisinopril, and 31.4% for placebo.
Mechanism of Reduced Cough with Losartan
The lower incidence of cough with losartan is attributed to its mechanism of action. Unlike ACE inhibitors, which increase bradykinin levels (a known cause of cough), losartan blocks the angiotensin II receptor without affecting bradykinin metabolism . This distinction is crucial in reducing the cough reflex associated with ACE inhibitors.
Severity and Frequency of Cough
Patient-Reported Outcomes
Patients treated with losartan report significantly lower severity and frequency of cough compared to those on ACE inhibitors. Visual analogue scale (VAS) scores from various studies indicate that patients on losartan experience less frequent and severe coughing episodes than those on lisinopril . For instance, in one study, the mean VAS score for cough frequency was 1.2 for losartan, compared to 4.0 for lisinopril.
Comparative Studies in Different Populations
In elderly hypertensive patients, losartan also demonstrated a lower incidence of cough (18%) compared to lisinopril (97%) and was similar to metolazone (21%). This finding underscores losartan's efficacy in reducing cough across various patient demographics.
Safety and Tolerability
Adverse Events and Discontinuation Rates
Losartan is generally well-tolerated, with adverse events such as headache, dizziness, and upper respiratory infections occurring at rates similar to placebo . The rate of discontinuation due to adverse events is lower for losartan (2.3%) compared to placebo (3.7%) and significantly lower than for ACE inhibitors .
Laboratory and Clinical Safety
No unexpected or clinically significant laboratory adverse events have been reported with losartan. First-dose hypotension and withdrawal effects like rebound hypertension are rare, further supporting its safety profile .
Conclusion
Losartan presents a viable alternative to ACE inhibitors for hypertensive patients who experience ACE inhibitor-induced cough. Its lower incidence, severity, and frequency of cough, combined with a favorable safety and tolerability profile, make it an effective and patient-friendly option for managing hypertension.
Sources and full results
Most relevant research papers on this topic