INCIDENCE OF ANGIOTENSIN CONVERTING ENZYME INHIBITOR INDUCED COUGH

Abstract

Objective: The objective of our study was to assess the incidence of ACE
inhibitor induced cough in our population. Study Design: Mainly prospective, multicenter, open labeled study of 500
patients. Setting: Department of Medicine of Combined Military Hospital (CMH) Lahore and PNS SHIFA (Naval
Hospital) Karachi. Period February 2000 to February 2001. Material and Method: 500 Patients using eight different
types of ACE inhibitors were selected and an especially designed Performa was completed. In this study preference
was given to patients to whom ACE inhibitors were prescribed for the first time. Patients with concomitant respiratory
diseases like chronic bronchitis, chronic obstructive airway disease and pulmonary tuberculosis were excluded. Patients
were followed up on fortnightly basis for six to eight months. On each visit besides recording their blood pressure they
were specifically inquired about occurrence of any cough. They were also requested to complete the cough
questionnaire. Results: A dry cough incidence with different ACE inhibitors was 12.8%, ranging from 6.8% with
Captopril to 17.3% with Enalapril. The dry cough was mild in the majority of our patients and they were willing to
continue their ACE inhibitor, because their blood pressure was well controlled with it. Only a small percentage 3.6%
discontinued ACE inhibitor due to severe bothersome, irritating cough. They switched over to other group of
antihypertensives mostly Angiotensin II antagonists. Incidence of cough was slightly more in females (14.3%) as
compared to males (12.0%). Conclusion: Although ACE inhibitors have a low incidence of adverse effects, a dry cough
was class effect occurring with all ACE inhibitors.