High Incidence of Cough among Users of Angiotensin-Converting Enzyme Inhibitors

Objective: To evaluate the incidence of cough among patients newly diagnosed with hypertension initiated on Angiotensin-Converting Enzyme Inhibitors (ACEI). Design: A Prospective Study. Setting: Two primary healthcare centers, Bahrain. Method: Newly diagnosed patients with hypertension who were initiated on ACEI or angiotensin receptors blockers (ARBs) were included in the study. The patients were followed for one year starting from 2 January 2016 to 31 December 2016. The following data were documented: age, sex, smoking, body mass index (BMI), and concomitant co-morbid diseases, the onset of cough, duration, drug discontinuation, and the cough disappearance after discontinuation. Result: Eighty patients were included in the analysis. Sixty-five (81%) patients received ACEI and 15 (19%) were on ARBs. Forty-three patients (54%) were females. Cough developed in 24 (37%) patients. Perindopril was the only ACEI prescribed. The mean cough onset is 12.7 days. After stopping or changing the drug, the mean for cough disappearance was 13.3 days. There was a statistically significant gender difference in ACEI-induced cough. Cough developed in 17 (70.8%) females compared to 7 (29.2%) males; P=0.044. There was no significant difference regarding age (P=0.79) or BMI (P=0.37). Conclusion: The incidence of cough is unexpectedly high among our newly diagnosed hypertensive patients initiated on Perindopril. It is much higher among females. Larger study is needed to examine this common, often intolerable, adverse effect.