Angiotensin-converting enzyme-related cough among Chinese-Americans

Few studies have examined the relationship between ethnicity and tolerance of hypertension medications. We investigated the perception that Chinese-Americans may have a higher incidence of chronic cough from angiotensin-converting enzyme inhibitors.

We searched electronic databases to identify patients who had received a new lisinopril prescription. This cohort was separated into 295 patients of Chinese descent and 4263 patients in the general population group with an instrument that used surnames to identify Chinese ethnicity. For those who discontinued lisinopril within 1 year, we reviewed medical records to determine reasons for discontinuation. We compared rates of discontinuation overall and due to cough by ethnic group (Chinese vs general population).

The Chinese population was more likely to discontinue their medication (47%) than the general population (31%). When the cause for discontinuation was examined, cough was significantly higher among Chinese, with a relative risk of 2.53; 95% confidence interval (CI), 2.11-3.03. The risk for angioedema was <1%, and no difference in the risk of angioedema was found between the 2 groups. When controlled for age, sex, and smoking, the risk of cough among Chinese-Americans remained significant (relative risk 2.63; 95% CI, 2.20-3.15).

We observed that our Chinese group was more than twice as likely as the general population to discontinue lisinopril due to cough, controlling for the influence of sex, age, and smoking.