ACE INHIBITORS

Persistent dry cough is commonest undesirable effect of the angiotensin convertingenzyme inhibitors. The mechanism of cough due to ACE inhibitors is uncertain, but most likelyis due to the cough mediators as substance P agents & brdykinin which are degraded byACE inhibitors. Objective: To compare the incidence of cough in hypertensives which wereprescribed lisinopril, perindopril & ramipril. Study Design: Mainly cross sectional prospectivemulticenter, open labeled study of 100 patients. Place & Duration of Study: Department ofMedicine of University Medical Diagnostic Centre & District Head Quarter Hospital Sargodha,period January 2016 to June 2016. Methodology: 100 Patients using three types of ACEinhibitors were selected and an especially designed performa was completed. In our study wegave preference to those patients who were prescribed ACE inhibitors for the first time. Thepatients were instructed (at the baseline visit) to inform during the succeeding visit about theonset of any adverse drug reactions like cough, hypotension, headache, dizziness, fatigue,nausea, angioedema. Patients were not informed that incidence of cough was the main seek ofthe study, so there was no chance for Hawthorne effect. Results: The incidence of ACE inhibitorinduced cough has been reported to as: perindopril was 5.4 %, ramipril 6.89 % & lisinopril 8.82%. Overall incidence of dry cough was 7.0 % with three different ACE inhibitors. The onsetof cough after taking ACE inhibitors ranges from within days of the first dose to months afterstarting the therapy. Cough usually resolves within 1 to 4 weeks after the cessation of treatment.Conclusion: Chronic dry cough is a general consequence of angiotensin converting enzymeinhibitors. The cough is also associated with irritating & tickling sensations in throat.