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.