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Angiotensin-converting enzyme inhibitors and cough: a prospective evaluation in hypertension and in congestive heart
Insights
Angiotensin-converting enzyme inhibitors (ACE-I) cause a dry cough in 18.6% of patients. This cough often necessitates discontinuation, particularly in congestive heart failure (CHF) patients.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Angiotensin-converting enzyme inhibitors (ACE-I) are primary treatments for hypertension and heart failure.
- A common side effect, dry cough, frequently leads to treatment discontinuation.
- Existing data on cough incidence and significance with ACE-I therapy are conflicting.
Purpose of the Study:
- To determine the incidence of cough in patients receiving ACE-I for hypertension and congestive heart failure (CHF).
- To assess the clinical significance and impact of ACE-I-induced cough on treatment adherence.
Main Methods:
- Prospective follow-up of 268 patients (164 hypertension, 104 CHF) on ACE-I therapy for at least 1 year.
- Systematic questioning regarding cough and other side effects.
- Sequential trial of up to three different ACE-I agents in patients who developed cough.
Main Results:
- Cough developed in 18.6% of all patients (14% hypertension, 26% CHF).
- Onset of cough was significantly faster in CHF patients (12.3 weeks) vs. hypertension patients (24.7 weeks).
- 50% of patients with cough discontinued ACE-I, predominantly in the CHF group; 18% of CHF patients required discontinuation versus 4% of hypertension patients.
Conclusions:
- ACE-I-induced cough is a significant issue, particularly in CHF patients, often leading to treatment cessation.
- The majority of patients experiencing cough on one ACE-I also experience it on others.
- While cough can be severe, in some cases it is tolerated or resolves over time.
Abstract:
Angiotensin-converting enzyme inhibitors (ACE-I) have become the mainstem of antihypertensive therapy and first-choice agents for vasodilatation in congestive heart failure (CHF). A typical dry cough is the main cause for discontinuation of ACE-I therapy. Data about the incidence, course, and clinical significance of this side effect are conflicting. This study determined the incidence of cough in ACE-I treated patients with hypertension and with CHF and to appreciate its clinical significance; 268 ACE-I treated patients, 164 with hypertension and 104 with CHF were prospectively followed for at least 1 year and specifically questioned about cough and other side effects. In those in whom cough developed, a second and then a third ACE-I were tried. Cough developed in 50 (18.6%) of the 268 patients; 23 patients with hypertension (14%) had coughs 24.7 +/- 17.1 (SD) weeks after initiation of therapy; 27 patients with CHF (26%) had coughs 12.3 +/- 12 (SD) weeks after the start of ACE-I therapy (P = 0.005). All but three patients had coughs also on the second and third ACE-I. The time from the beginning of therapy to the onset of cough was significantly shorter with the second than the first drug. ACE-I agents had to be discontinued in 50% of the patients in whom coughs developed, most of them in the CHF group. In the others, cough was well tolerated or disappeared during subsequent months. The incidence of cough, which necessitated discontinuation of ACE-I treatment, was 4% among patients with hypertension and 18% among patients with CHF (P < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)