ACE INHIBITORS

COMPARISON OF ACE INHIBITORS (PERINDOPRIL, RAMIPRIL & LISINOPRIL) INDUCED COUGH.

Abstract

Persistent dry cough is commonest undesirable effect of the angiotensin converting
enzyme inhibitors. The mechanism of cough due to ACE inhibitors is uncertain, but most likely
is due to the cough mediators as substance P agents & brdykinin which are degraded by
ACE inhibitors. Objective: To compare the incidence of cough in hypertensives which were
prescribed lisinopril, perindopril & ramipril. Study Design: Mainly cross sectional prospective
multicenter, open labeled study of 100 patients. Place & Duration of Study: Department of
Medicine of University Medical Diagnostic Centre & District Head Quarter Hospital Sargodha,
period January 2016 to June 2016. Methodology: 100 Patients using three types of ACE
inhibitors were selected and an especially designed performa was completed. In our study we
gave preference to those patients who were prescribed ACE inhibitors for the first time. The
patients were instructed (at the baseline visit) to inform during the succeeding visit about the
onset of any adverse drug reactions like cough, hypotension, headache, dizziness, fatigue,
nausea, angioedema. Patients were not informed that incidence of cough was the main seek of
the study, so there was no chance for Hawthorne effect. Results: The incidence of ACE inhibitor
induced cough has been reported to as: perindopril was 5.4 %, ramipril 6.89 % & lisinopril 8.82
%. Overall incidence of dry cough was 7.0 % with three different ACE inhibitors. The onset
of cough after taking ACE inhibitors ranges from within days of the first dose to months after
starting the therapy. Cough usually resolves within 1 to 4 weeks after the cessation of treatment.
Conclusion: Chronic dry cough is a general consequence of angiotensin converting enzyme
inhibitors. The cough is also associated with irritating & tickling sensations in throat.