title: Incidence of discontinuation of angiotensin-converting enzyme inhibitors due to cough, in a primary healthcare centre in Singapore.
abstract: BACKGROUND
  The incidence of cough induced by angiotensin-converting enzyme (ACE) inhibitors has been reported to be 5%-20%, with less than half of affected patients requiring discontinuation due to persistent cough. However, the incidence in the local Asian population has not been studied. This study aimed to objectively evaluate the incidence of discontinuation of ACE inhibitors due to cough, in a primary healthcare centre in Singapore.
  
  
  METHODS
  We retrospectively reviewed the medical records, both electronic and written, of patients who attended Tampines Polyclinic to identify those who were newly prescribed ACE inhibitors. The written medical records were analysed to identify patients who discontinued the use of ACE inhibitors and to find out the reasons for discontinuation.
  
  
  RESULTS
  A total of 424 patients were identified during the study period. Out of the 424 patients, 129 (30.4%) discontinued the use of ACE inhibitors due to cough. Overall, 90 (21.2%) patients who were initially started on ACE inhibitors were eventually switched to angiotensin receptor blockers (ARBs).
  
  
  CONCLUSIONS
  In our cohort, the incidence of discontinuation of ACE inhibitors due to cough is higher than most other studies. The relationship between ethnicity and tolerance of medications should not be underestimated. As there is a high incidence of discontinuation of ACE inhibitors due to cough in the local population, ARBs may be a reasonable substitute as a first-line medication, if clinically indicated.
authors.affiliation: Tampines Polyclinic, 1 Tampines Street 41, Singapore 529203. ng.lai.peng@singhealth.com.sg.
authors.forename: Lai Peng
authors.initials: LP
authors.lastname: Ng
authors.forename: Paul Soo Chye
authors.initials: PS
authors.lastname: Goh
mesh_terms: D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects*; D003371:Cough / Q000139:chemically induced*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D010820:Physicians; D011320:Primary Health Care / Q000458:organization & administration; D012189:Retrospective Studies; D012846:Singapore; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors