Angiotensin-converting enzyme inhibitors, known as ACE Inhibitors, are drugs used to prevent, treat, or improve symptoms in conditions such as high blood pressure, coronary artery disease, heart failure, and diabetes. These drugs can cause a chronic cough that can affect your quality of life.

An ACE-induced cough occurs in about 10% of those taking the medication, though some studies show even higher rates. The cough may develop within hours after taking the first dose or as much as weeks or months later.

Symptoms

This cough is typically dry with a tickling or scratching feeling in the throat.

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Treatment

Mechanisms and Prevalence

ACE inhibitor-induced cough is a common side effect of this class of medications, which are widely used to treat high blood pressure and other cardiovascular conditions. The prevalence of ACE inhibitor cough varies widely, with studies reporting rates between 5% and 35% of patients taking these medications. Women and non-smokers appear to be more susceptible to developing this side effect.

The exact mechanism behind ACE inhibitor cough is not fully understood, but it is thought to be related to the accumulation of substances like bradykinin and substance P in the airways. Normally, the ACE enzyme breaks down these compounds. However, when ACE is inhibited, they can build up and irritate sensory nerves in the airways, triggering a cough reflex.

Interestingly, the onset of an ACE inhibitor cough can vary significantly. Some patients may develop a cough within hours of taking their first dose, while for others, it may take weeks or even months to appear. This variability in onset can sometimes lead to misdiagnosis, as the connection between the medication and the cough may not be immediately apparent.

Management of ACE inhibitor cough typically involves discontinuing the medication and switching to an alternative treatment, such as an angiotensin receptor blocker (ARB). In some cases, the cough may resolve even if the ACE inhibitor is continued, but this is not predictable.

You should see your doctor, who will discuss whether to change your medication.

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The stories shared below are not written by Buoy employees. Buoy does not endorse any of the information in these stories. Whenever you have questions or concerns about a medical condition, you should always contact your doctor or a healthcare provider.

Jeffrey M. Rothschild, MD, MPH.

Associate Professor of Medicine, Brigham and Women’s Hospital

Dr. Rothschild has been a faculty member at Brigham and Women’s Hospital where he is an Associate Professor of Medicine at Harvard Medical School. He currently practices as a hospitalist at Newton Wellesley Hospital. In 1978, Dr. Rothschild received his MD at the Medical College of Wisconsin and trained in internal medicine followed by a fellowship in critical care medicine. He also received an MP...

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References

Yılmaz İ. Angiotensin-Converting Enzyme Inhibitors Induce Cough. Turk Thorac J. 2019;20(1):36-42. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6340691/
Dicpinigaitis PV. Angiotensin-Converting Enzyme Inhibitor-Induced Cough: ACCP Evidence-Based Clinical Practice Guidelines. Chest. 2006;129(1 Suppl):169S-173S. https://journal.chestnet.org/article/S0012-3692(15)52845-6/fulltext
Pinto B, Jadhav U, Singhai P, Sadhanandham S, Shah N. ACEI-induced cough: A review of current evidence and its practical implications for optimal CV risk reduction. Indian Heart J. 2020;72(5):345-350. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7670268/