Angiotensin-Converting Enzyme Inhibitor Induced Cough in Chinese Patients: a Systematic Review and Meta-analysis

Purpose: To determine the risk of angiotensin converting enzyme inhibitor (ACEI)-induced cough compared to non-ACEI cough among Chinese patients. Methods: A comprehensive search was conducted including randomized controlled trials, case-control studies and observational studies that compared ACEI treatment with control treatment in MEDLINE, EMBASE, CINAHL, Scopus, Google Scholar and ProQuest Dissertations & Theses Global. The studies which contained: Chinese population, ACEI, non-ACEI, and indications for the treatment of ACEI were included. The pooled risk ratios (RRs) and 95% confidence intervals (CIs) were calculated to compare the relative risk of cough between ACEIs and non-ACEI drugs based on the events of reported cough in each study. Results: Eleven randomized controlled trials were included with a total of 1815 patients. The total number of cough events in ACEI treatment was 101 in 930 patients (11%) and 20 in 885 patients (2%) in the Non-ACEI treatment. The pooled RR was 5.16 (95% CI: 3.39-7.85) under fixed model. The discontinuation number of single ACEI treatment due to coughing side effect was 21 and the withdrawal rate was 4.13%. Only two patients discontinued non-ACEIs treatment due to the intolerable cough and the withdrawal rate was 0.34%. The overall RR of withdrawal related to cough was 7.06 (95% CI: 2.49-20.04). Conclusions: The pooled risk of the incidence of ACEI-induced cough was about five times higher than that of non-ACEI-induced cough in Chinese population. The risk of withdrawal events related to cough in the single ACEI treatment was seven times of that in the non-ACEI treatment.