Dechallenge and rechallenge method showed different incidences of cough among four ACE-Is.
OBJECTIVE
To determine the incidence of cough secondary to (1) Cilazapril, (2) Enalapril, (3) Imidapril, and (4) Perindopril and their efficacy in the control of hypertension.


METHODS
Randomized double-blind study conducted in selected medical centers in the Philippines from the first quarter of 1999 to March, 2001.


RESULTS
A total of 301 patients, aged 28-86 years with stage I or II hypertension were included. Patients were randomized to Cilazapril 2.5-5.0 mg/day (n=70), Enalapril 10-20 mg/day (n=82), Perindoril 4-8 mg/day (n=73), or Imidapril 10-20 mg/day (n=76). Hydrochlorothiazide 12.5 mg/day was added if needed. Using a dechallenge and rechallenge method, a strict criteria to attribute cough to angiotensin converting enzyme inhibitors (ACE-Is) not yet used in previous reports, the cough incidence were as follows: (1) Cilazapril--22.86% (16/70), (2) Enalapril--21.95% (18/82), (3) Perindopril--10.96% (6/73), and (4) Imidapril--13.16% (10/76) (P=0.041). Control of hypertension was significantly better with Enalapril during the first follow-up period.


CONCLUSIONS
Statistically significant differences in the incidence of cough among the studied ACE-Is were noted. Control of hypertension was observed to be better in those with a higher incidence of cough; however, the mean change of both systolic and diastolic blood pressure levels were not significantly different.
Tumanan-Mendoza
Bernadette A
BA
Department of Internal Medicine, Manila Doctors Hospital, U.N. Avenue, Manila, Philippines 1000. bernadette.tumanan@gmail.com
Dans
Antonio L
AL
Villacin
Lourdes Lucienne
LL
Mendoza
Victor L
VL
Rellama-Black
Sofia
S
Bartolome
Moises
M
Ragual
Jimmy
J
Flor
Benjamin
B
Valdez
Josephine
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects*; D000959:Antihypertensive Agents / Q000009:adverse effects; D017315:Cilazapril / Q000009:adverse effects; D003371:Cough / Q000139:chemically induced* / Q000453:epidemiology; D004311:Double-Blind Method; D004656:Enalapril / Q000009:adverse effects; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000453:epidemiology; D048289:Imidazolidines / Q000009:adverse effects; D015994:Incidence; D008297:Male; D008875:Middle Aged; D020913:Perindopril / Q000009:adverse effects; D010679:Philippines / Q000453:epidemiology; D016896:Treatment Outcome
D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D048289:Imidazolidines; D017315:Cilazapril; D004656:Enalapril; C065166:imidapril; D020913:Perindopril