High blood pressure, also known as hypertension, is a common condition where the force of blood against artery walls is consistently too high. Managing high blood pressure often involves medication, which helps reduce the risk of serious health complications. Adhering to prescribed medication regimens is important for effective blood pressure control. While these medications are beneficial, some individuals may experience side effects, including an irritating cough. This article explores which blood pressure medications are associated with coughing.
ACE Inhibitors and Cough
Angiotensin-Converting Enzyme (ACE) inhibitors are a class of medications frequently prescribed to relax blood vessels and lower blood pressure. They work by blocking the enzyme responsible for producing angiotensin II, a substance that narrows blood vessels. Common examples of ACE inhibitors include lisinopril (marketed as Zestril or Prinivil), enalapril (known as Vasotec), and ramipril (sold as Altace). This class of drugs is effective in managing hypertension and protecting the heart.
Despite their benefits, ACE inhibitors are the primary blood pressure medications known to induce a persistent cough. This side effect can affect a significant number of patients, with estimates suggesting that between 5% and 20% of individuals taking these drugs may develop a cough. The occurrence of this cough is not directly related to the medication’s ability to lower blood pressure, but rather to a distinct physiological process. The cough usually appears within the first few weeks or months of starting the medication.
The Nature of the Cough
The cough associated with ACE inhibitors is commonly described as a dry, non-productive cough, meaning it does not bring up mucus or phlegm. It is often persistent and irritating, leading to discomfort and potentially disrupting daily activities or sleep. Some individuals report a tickling sensation in their throat that triggers the coughing episodes.
The underlying physiological mechanism for this cough involves the accumulation of bradykinin in the airways. ACE inhibitors not only prevent the formation of angiotensin II but also inhibit the breakdown of bradykinin. Elevated levels of bradykinin can irritate sensory nerve endings in the respiratory tract, leading to the coughing reflex. The cough’s onset can vary, sometimes appearing within hours or days of starting the medication, though it more commonly develops over several weeks to months.
Addressing the Cough
If a cough develops while taking blood pressure medication, discuss it with a healthcare provider. Do not discontinue medication without medical guidance, as stopping abruptly can lead to uncontrolled blood pressure and serious health risks. A doctor can evaluate the situation to determine if the cough is medication-related and make appropriate adjustments to the treatment plan.
Healthcare providers may consider several approaches to address an ACE inhibitor-induced cough. One option might involve a dose adjustment, though this is less common for resolving the cough. More frequently, the doctor may recommend switching to an alternative class of blood pressure medication less likely to cause this side effect. Other medication classes do not typically lead to bradykinin accumulation.
Angiotensin Receptor Blockers (ARBs) are often a preferred alternative to ACE inhibitors because they work through a similar pathway but do not affect bradykinin levels. Common ARBs include losartan (known as Cozaar), valsartan (marketed as Diovan), and candesartan (sold as Atacand). Other medication options include calcium channel blockers, diuretics, or beta-blockers, each working through different mechanisms to lower blood pressure. The choice of alternative medication depends on individual patient needs and other health conditions.