Losartan cough
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Losartan and Cough: A Comparative Analysis
Introduction to Losartan and ACE Inhibitor-Induced Cough
Cough is a well-documented side effect of angiotensin-converting enzyme (ACE) inhibitors, often leading to discontinuation of these medications. Losartan, an angiotensin II receptor antagonist, has been studied as an alternative for patients who develop cough with ACE inhibitors. This article synthesizes findings from multiple studies comparing the incidence of cough in patients treated with losartan versus those treated with ACE inhibitors like lisinopril.
Incidence of Cough with Losartan vs. Lisinopril
Several studies have consistently shown that losartan is associated with a significantly lower incidence of cough compared to lisinopril. In a multicenter, double-blind trial involving 135 hypertensive patients with a history of ACE inhibitor-induced cough, the incidence of cough was 29% for losartan, significantly lower than the 72% observed with lisinopril . Another study reported similar findings, with 36.7% of patients on losartan experiencing cough compared to 87.5% on lisinopril.
Severity and Frequency of Cough
The severity and frequency of cough were also assessed using visual analogue scales (VAS). Patients treated with losartan reported significantly lower cough frequency and severity compared to those on lisinopril . This suggests that not only is the incidence of cough lower with losartan, but the impact on patients' quality of life is also reduced.
Mechanism Behind 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 and can lead to cough, losartan does not affect bradykinin metabolism. This difference in pharmacological action likely explains the reduced cough incidence with losartan .
Comparative Studies with Other Medications
In addition to lisinopril, losartan has been compared with other medications like hydrochlorothiazide and metolazone. The incidence of cough with losartan was found to be similar to that with hydrochlorothiazide (34%) and metolazone (21%), further supporting its favorable profile in terms of cough .
Case Reports and Observational Studies
While most studies support the lower incidence of cough with losartan, there are rare case reports of losartan-induced cough. One such case involved a patient whose cough resolved after switching from losartan to enalapril, an ACE inhibitor. However, these instances are exceptions rather than the norm.
Conclusion
Losartan is a viable alternative for hypertensive patients who develop cough with ACE inhibitors. The incidence, severity, and frequency of cough are significantly lower with losartan compared to lisinopril, making it a preferable option for those affected by ACE inhibitor-induced cough. This makes losartan a promising treatment for hypertension, particularly in patients who are intolerant to ACE inhibitors.
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