Double-blind comparison of losartan, lisinopril and hydrochlorothiazide in hypertensive patients with a previous angiotensin converting enzyme inhibitor-associated cough.
OBJECTIVE
To compare the incidence of cough with the angiotensin II antagonist losartan, the angiotensin converting enzyme inhibitor lisinopril, and hydrochlorothiazide in hypertensive patients with previous angiotensin converting enzyme inhibitor cough.


METHODS
Double-blind random stratified parallel-group comparison of losartan 50 mg, lisinopril 20 mg and hydrochlorothiazide 25 mg, each given once daily for a maximum of 8 weeks. Cough detected by self-administered questionnaire (the primary end-point) and cough frequency by visual analogue scale (a secondary end-point).


METHODS
Hypertension clinics in 20 centres in 11 countries.


METHODS
135 hypertensive patients, all non-smokers, with angiotensin converting enzyme inhibitor cough confirmed by lisinopril rechallenge then placebo dechallenge.


RESULTS
Incidence of cough with losartan (29%) lower than that for lisinopril (72%; P < 0.01) and similar to that for hydrochlorothiazide (34%). Cough frequency by visual analogue scale lower for losartan than lisinopril (P < 0.01) and similar to that for hydrochlorothiazide.


CONCLUSIONS
The specific selective angiotensin II receptor (AT1) antagonist losartan does not cause cough in patients with previous angiotensin converting enzyme inhibitor cough. Angiotensin converting enzyme inhibitor cough is likely to be related to kininase II inhibiting action.
Ramsay
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LE
University Department of Medicine and Pharmacology, Royal Hallamshire Hospital, Sheffield, UK.
Yeo
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D047228:Angiotensin II Type 1 Receptor Blockers / Q000009:adverse effects / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use*; D003371:Cough / Q000139:chemically induced*; D004232:Diuretics / Q000009:adverse effects / Q000627:therapeutic use; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D006852:Hydrochlorothiazide / Q000009:adverse effects / Q000627:therapeutic use*; D006973:Hypertension / Q000188:drug therapy*; D015994:Incidence; D017706:Lisinopril / Q000009:adverse effects / Q000627:therapeutic use*; D019808:Losartan / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement
D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D004232:Diuretics; D006852:Hydrochlorothiazide; D017706:Lisinopril; D019808:Losartan