Angiotensin converting enzyme inhibitors and cough--a north Indian study.
Cough is an important side effect of Angiotensin Converting Enzyme Inhibitor (ACEI) therapy. The incidence of cough was investigated in a prospective 8 week study in 250 hypertensive patients receiving ACEI alone or in combination with other agents. Enalapril (5-20 mg/day), Lisinopril (5-20 mg/day), Captopril (25-75 mg/day) or Ramipril (5-15 mg/day) was prescribed to patients, who were followed up at weekly visits. Cough developed in 73 of the 250 patients i.e. an incidence of 29.2%. Females had a higher incidence of cough as compared to males--37.9% versus 15.5% (p < 0.001) and there was no significant difference in the cough incidence in the various age groups. A dry, non-productive cough developed in all patients within 4 weeks of ACEI initiation. Increased nocturnal intensity of cough was reported by 79.4% patients. Cough incidence was 34.4%, 24.3% and 18.1% in patients on Enalapril, Ramipril and Lisinopril, respectively. Cough was not dose related and was not related to smoking. There was no statistically significant difference among patients on ACEI alone or in combination with beta blockers, calcium channel blockers or diuretics. Of the 18 patients with ACEI induced cough who received Indomethacin, 50 mg bid, 8 reported complete cure and cough was reduced in intensity in the remaining ten.
Department of Medicine, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi-110 002, India.
N P
NP
Singh
M
M
Uppal
S
S
Anuradha
A
A
Agarwal
S N
SN
Rizvi
D000328:Adult; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D002216:Captopril / Q000009:adverse effects / Q000627:therapeutic use; D003371:Cough / Q000139:chemically induced* / Q000188:drug therapy / Q000453:epidemiology*; D004656:Enalapril / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D015994:Incidence; D007194:India / Q000453:epidemiology; D007213:Indomethacin / Q000008:administration & dosage; D017706:Lisinopril / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D017257:Ramipril / Q000009:adverse effects / Q000627:therapeutic use; D018570:Risk Assessment
D000806:Angiotensin-Converting Enzyme Inhibitors; D004656:Enalapril; D002216:Captopril; D017706:Lisinopril; D017257:Ramipril; D007213:Indomethacin