Which blood pressure medications cause coughing
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Blood Pressure Medications and Cough: A Comprehensive Overview
Introduction to ACE Inhibitors and Cough
Angiotensin-converting enzyme inhibitors (ACE inhibitors) are commonly prescribed medications for managing hypertension. However, a notable side effect associated with these drugs is the development of a persistent dry cough. This article synthesizes research findings on the incidence and mechanisms of cough induced by various ACE inhibitors.
ACE Inhibitors and Cough Incidence
Enalapril and Ramipril
Studies have shown that both enalapril and ramipril can significantly increase the sensitivity of the cough reflex in patients who develop a cough during treatment. In a controlled study, three out of twenty patients reported cough symptoms when taking either enalapril or ramipril, but not when on a placebo. This suggests a direct link between these medications and the development of cough.
Comparative Incidence Among ACE Inhibitors
A randomized study comparing the incidence of cough among four ACE inhibitors—cilazapril, enalapril, imidapril, and perindopril—found varying rates of cough. Cilazapril and enalapril had higher incidences of cough (22.86% and 21.95%, respectively) compared to perindopril (10.96%) and imidapril (13.16%). This indicates that while all ACE inhibitors can cause cough, the likelihood varies between different drugs.
Eprosartan vs. Enalapril
In a 26-week study comparing eprosartan, an angiotensin receptor blocker (ARB), with enalapril, it was found that enalapril was associated with a significantly higher risk of developing a persistent dry cough. The incidence of cough was 3.45 times higher in the enalapril group compared to the eprosartan group . This highlights the potential benefit of ARBs in patients who experience cough with ACE inhibitors.
Mechanisms Behind ACE Inhibitor-Induced Cough
The cough associated with ACE inhibitors is believed to be mediated by the accumulation of bradykinin, substance P, and prostaglandins in the lungs. These substances are normally degraded by the angiotensin-converting enzyme, and their accumulation can lead to irritation and cough. This mechanism is supported by the observation that switching from an ACE inhibitor to an ARB, which does not inhibit the enzyme, often resolves the cough.
Genetic Factors and ACE Inhibitor-Induced Cough
Genetic variation may also play a role in the incidence of ACE inhibitor-induced cough. Studies suggest that genetic factors could account for 30% to 50% of the variability in blood pressure response and the likelihood of developing a cough. However, more research is needed to fully understand the genetic predispositions that contribute to this side effect.
Conclusion
ACE inhibitors are effective in managing hypertension but are frequently associated with a persistent dry cough. The incidence of cough varies among different ACE inhibitors, with enalapril and ramipril being more commonly implicated. The underlying mechanism involves the accumulation of bradykinin and other substances in the lungs. For patients who develop a cough, switching to an ARB like eprosartan or losartan may be beneficial. Understanding the genetic factors that contribute to this side effect could further improve patient management and medication selection.
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