Abstract
Introduction: Angiotensin-converting enzyme inhibitors (ACEi) are among the main anti-hypertensive medications. While they are generally well tolerated, dry cough is one of their important side effects, with a frequency of up to 10 percent. Medications that are associated with increased ACEi-related cough frequency are not well described. We wanted to evaluate medications that might have an effect on ACEi-related cough.
Methods: This study was designed as a post-hoc analysis of our previously published study. Patients who were on ACEi were identified, and demographics, comorbidities, laboratory data, and medications were retrieved via electronic medical records. Patients who reported cough and whose cough ceased after ACEi withdrawal were defined as having an "ACEi-related cough." Patients were grouped according to their ACEi-related cough presence.
Results: One hundred and twenty-one patients were included in the study, of whom 14 experienced ACEi-related coughs. All medications except for low-dose acetylsalicylic acid (ASA) and calcium channel blockers (CCB) were similar between the groups. Low-dose ASA use was significantly higher among patients who experienced ACEi-related cough (50% vs. 16.8%, p = 0.04). On the other hand, CCB use was associated with lower ACEi-related cough (7.7% vs. 35.5%, p = 0.03). Medications other than ASA and CCB, demographics, comorbidities, and laboratory data were similar across the groups.
Discussion: ACEi-related cough risk is higher among patients on low-dose ASA and lower among patients on CCB. Further studies are needed to demonstrate if there is a “safe” acetylsalicylic acid dose that is not associated with ACEi-related cough.
Keywords
hypertension angiotensin converting enzyme inhibitors acetylsalicylic acid calcium channel blockers cough
References
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- Kidney Disease: Improving Global Outcomes (KDIGO) Diabetes Work Group. KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease. Kidney Int. 2022;102(5S):S1-S127. doi:10.1016/j.kint.2022.06.008
- Tseng DS, Kwong J, Rezvani F, Coates AO. Angiotensin-converting enzyme-related cough among Chinese-Americans. Am J Med. 2010;123(2):183.e11-183.e1.83E15. doi:10.1016/j.amjmed.2009.06.032
- Borghi C, Cicero AF, Agnoletti D, Fiorini G. Pathophysiology of cough with angiotensin-converting enzyme inhibitors: How to explain within-class differences?. Eur J Intern Med. 2023;110:10-15. doi:10.1016/j.ejim.2023.01.005
- Kaufman J, Casanova JE, Riendl P, Schlueter DP. Bronchial hyperreactivity and cough due to angiotensin-converting enzyme inhibitors. Chest. 1989;95(3):544-548. doi:10.1378/chest.95.3.544
- Cottin V, Cordier JF. Bronchospasme, toux, et bronchiolite iatrogéniques médicamenteux. Aspects étiologiques et physiopathologiques [Iatrogenic drug-induced bronchospasm, cough, and bronchiolitis. Etiologic and physiopathologic aspects]. Rev Mal Respir. 1996;13(4):339-360.
- Tenenbaum A, Grossman E, Shemesh J, Fisman EZ, Nosrati I, Motro M. Intermediate but not low doses of aspirin can suppress angiotensin-converting enzyme inhibitor-induced cough. Am J Hypertens. 2000;13(7):776-782. doi:10.1016/s0895-7061(00)00268-5
- Tumanan-Mendoza BA, Dans AL, Villacin LL, et al. Dechallenge and rechallenge method showed different incidences of cough among four ACE-Is. J Clin Epidemiol. 2007;60(6):547-553. doi:10.1016/j.jclinepi.2006.06.017
- Reisin L, Schneeweiss A. Spontaneous disappearance of cough induced by angiotensin-converting enzyme inhibitors (captopril or enalapril). Am J Cardiol. 1992;70(3):398-399. doi:10.1016/0002-9149(92)90630-h
- Sato A, Fukuda S. A prospective study of frequency and characteristics of cough during ACE inhibitor treatment. Clin Exp Hypertens. 2015;37(7):563-568. doi:10.3109/10641963.2015.1026040
Abstract
References
- Mancia G, Kreutz R, Brunström M, et al. 2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension: Endorsed by the International Society of Hypertension (ISH) and the European Renal Association (ERA). J Hypertens. 2023;41(12):1874-2071. doi:10.1097/HJH.0000000000003480
- Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines [published correction appears in J Am Coll Cardiol. 2018 May 15;71(19):2275-2279]. J Am Coll Cardiol. 2018;71(19):e127-e248. doi:10.1016/j.jacc.2017.11.006
- McDonagh TA, Metra M, Adamo M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure [published correction appears in Eur Heart J. 2021 Oct 14;:]. Eur Heart J. 2021;42(36):3599-3726. doi:10.1093/eurheartj/ehab368
- Kidney Disease: Improving Global Outcomes (KDIGO) Diabetes Work Group. KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease. Kidney Int. 2022;102(5S):S1-S127. doi:10.1016/j.kint.2022.06.008
- Tseng DS, Kwong J, Rezvani F, Coates AO. Angiotensin-converting enzyme-related cough among Chinese-Americans. Am J Med. 2010;123(2):183.e11-183.e1.83E15. doi:10.1016/j.amjmed.2009.06.032
- Borghi C, Cicero AF, Agnoletti D, Fiorini G. Pathophysiology of cough with angiotensin-converting enzyme inhibitors: How to explain within-class differences?. Eur J Intern Med. 2023;110:10-15. doi:10.1016/j.ejim.2023.01.005
- Kaufman J, Casanova JE, Riendl P, Schlueter DP. Bronchial hyperreactivity and cough due to angiotensin-converting enzyme inhibitors. Chest. 1989;95(3):544-548. doi:10.1378/chest.95.3.544
- Cottin V, Cordier JF. Bronchospasme, toux, et bronchiolite iatrogéniques médicamenteux. Aspects étiologiques et physiopathologiques [Iatrogenic drug-induced bronchospasm, cough, and bronchiolitis. Etiologic and physiopathologic aspects]. Rev Mal Respir. 1996;13(4):339-360.
- Tenenbaum A, Grossman E, Shemesh J, Fisman EZ, Nosrati I, Motro M. Intermediate but not low doses of aspirin can suppress angiotensin-converting enzyme inhibitor-induced cough. Am J Hypertens. 2000;13(7):776-782. doi:10.1016/s0895-7061(00)00268-5
- Tumanan-Mendoza BA, Dans AL, Villacin LL, et al. Dechallenge and rechallenge method showed different incidences of cough among four ACE-Is. J Clin Epidemiol. 2007;60(6):547-553. doi:10.1016/j.jclinepi.2006.06.017
- Reisin L, Schneeweiss A. Spontaneous disappearance of cough induced by angiotensin-converting enzyme inhibitors (captopril or enalapril). Am J Cardiol. 1992;70(3):398-399. doi:10.1016/0002-9149(92)90630-h
- Sato A, Fukuda S. A prospective study of frequency and characteristics of cough during ACE inhibitor treatment. Clin Exp Hypertens. 2015;37(7):563-568. doi:10.3109/10641963.2015.1026040
Details
| Primary Language | English |
|---|---|
| Subjects | Internal Diseases |
| Journal Section | Research Articles |
| Authors | |
| Early Pub Date | January 27, 2024 |
| Publication Date | January 29, 2024 |
| Submission Date | December 2, 2023 |
| Acceptance Date | January 8, 2024 |
| Published in Issue | Year 2024 Volume: 4 Issue: 1 |
