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  • Title: Cough with angiotensin converting enzyme inhibitors: how much of a problem?
    Author: Fletcher AE, Palmer AJ, Bulpitt CJ.
    Journal: J Hypertens Suppl; 1994 Jul; 12(2):S43-7. PubMed ID: 7965265.
    Abstract:
    PURPOSE: To review the occurrence of angiotensin converting enzyme (ACE) inhibitor-related cough, and to examine its impact on the quality of life. DATA SOURCES: Data from published reports, postmarketing surveillance studies, hospital case series and randomly allocated controlled trials were reviewed. Data are presented from a nested case-control study examining the effects of ACE inhibitor-related cough in 36 subjects compared with 69 controls on various measures of quality of life. RESULTS: Low rates of ACE inhibitor-related cough were found in postmarketing studies, ranging from 0.1% (early studies) to 3%. Much higher figures were reported from double-blind randomly allocated controlled trials using self-administered questionnaires; the net increase over baseline was between 13 and 25% compared to 2% with the comparator drug. The nested case-control study suggested that the ACE inhibitor-related cough is associated with some deterioration in well-being. During ACE inhibitor treatment the patients tended to be more fatigued (P = 0.1) and depressed (P < 0.05) than controls. Reports of a sore throat increased by 27% (P < 0.01). CONCLUSIONS: Cough is a common side effect of ACE inhibitor treatment, with conservative estimates suggesting that around one in 10 patients treated with an ACE inhibitor will develop a dry persistent cough. Half of these may be withdrawn from treatment. This cough is probably associated with some deterioration in well-being, but larger studies are required to confirm this.
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