INCIDENCE OF ANGIOTENSIN CONVERTING ENZYME INHIBITOR INDUCED COUGH

Objective: The objective of our study was to assess the incidence of ACEinhibitor induced cough in our population. Study Design: Mainly prospective, multicenter, open labeled study of 500patients. Setting: Department of Medicine of Combined Military Hospital (CMH) Lahore and PNS SHIFA (NavalHospital) Karachi. Period February 2000 to February 2001. Material and Method: 500 Patients using eight differenttypes of ACE inhibitors were selected and an especially designed Performa was completed. In this study preferencewas given to patients to whom ACE inhibitors were prescribed for the first time. Patients with concomitant respiratorydiseases like chronic bronchitis, chronic obstructive airway disease and pulmonary tuberculosis were excluded. Patientswere followed up on fortnightly basis for six to eight months. On each visit besides recording their blood pressure theywere specifically inquired about occurrence of any cough. They were also requested to complete the coughquestionnaire. Results: A dry cough incidence with different ACE inhibitors was 12.8%, ranging from 6.8% withCaptopril to 17.3% with Enalapril. The dry cough was mild in the majority of our patients and they were willing tocontinue their ACE inhibitor, because their blood pressure was well controlled with it. Only a small percentage 3.6%discontinued ACE inhibitor due to severe bothersome, irritating cough. They switched over to other group ofantihypertensives mostly Angiotensin II antagonists. Incidence of cough was slightly more in females (14.3%) ascompared to males (12.0%). Conclusion: Although ACE inhibitors have a low incidence of adverse effects, a dry coughwas class effect occurring with all ACE inhibitors.