Quality of Life and Antihypertensive Drug Therapy

Joel Handler, MD

In This Article

ACE Inhibitors

What about ACE-inhibitor cough? Its incidence is 5%-20%[27] and not dose related.[28] If a patient has a cough on 40 mg of lisinopril and the dose is reduced to 2.5 mg, chances are that the cough will not go away. There is a predisposition to ACE-inhibitor cough in women, blacks, and Asians ( Table 6 ).[29] Characteristics of the cough include a tickle in the throat, a mild cough, or a severe hacking cough. Occasionally, the cough bothers the family more than the patient; however, if a cough occurs, the ACE inhibitor should be stopped. It generally disappears within a period of a few days to several weeks. Bradykinin accumulation is probably responsible; there is no pulmonary dysfunction. A few small treatment trials showed a benefit from treating ACE-inhibitor cough with iron supplementation, nonsteroidal anti-inflammatory drugs, intermediate dose aspirin, nifedipine, and cromolyn.[30,31,32,33] These findings need to be replicated in larger studies for clinical credibility.