What is the clinical evidence from this study?

Study design: Cohort. Population: Hypertension (n=892). Intervention: ACE inhibitors vs. Non-black subjects. Primary outcome: Discontinuation of ACE inhibitor therapy due to cough (OR 4.0, 95% CI 1.7 to 9.1, p=<0.001).

November 1, 1996

Higher incidence of discontinuation of angiotensin converting enzyme inhibitors due to cough in black subjects

Q: What are the key findings of this study?

Black subjects had a significantly higher rate of discontinuing ACE inhibitor therapy due to cough compared to other racial groups (9.6% vs 2.4%; OR 4.0; 95% CI 1.7-9.1; p<0.001).

Q: What does this research mean for the field?

Black subjects have a significantly higher rate of discontinuing ACE inhibitor therapy due to cough compared to other racial groups. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Key Result

Black subjects had a significantly higher rate of discontinuing ACE inhibitor therapy due to cough compared to other racial groups (9.6% vs 2.4%; OR 4.0; 95% CI 1.7-9.1; p<0.001).

Study Design

Type

Cohort (n=892)

Multicenter

Structured PICO

Does black race increase the risk of discontinuation of ACE inhibitors due to cough in patients receiving their first-ever dose?

Population

892 patients from a tertiary hypertension clinic receiving their first-ever dose of ACE inhibitor therapy

Intervention

ACE inhibitor therapy in black subjects

Comparator

ACE inhibitor therapy in non-black subjects

Outcome

Discontinuation of ACE inhibitor therapy due to coughsafety

Black patients receiving ACE inhibitors have a significantly higher risk of discontinuing therapy due to cough compared to non-black patients.

Main Result

Effect estimate: OR 4.0 (95% CI 1.7 to 9.1)

Absolute Event Rate: 9.6% vs 2.4%

p-value: p=<0.001

Abstract

Objective To compare the rates of discontinuation of angiotensin converting enzyme (ACE) inhibitors in patients with different racial and ethnic backgrounds. Methods A registry from a tertiary hypertension clinic consisting of 892 patients who received their first-ever dose of ACE inhibitor therapy was examined. Surveillance for cough was prospective, systematic, and constant beginning in 1986 and routinely included a trial of sinusitis therapy, followed by withdrawal and rechallenge before discontinuation of drug. Results The prevalence (per 100 patients) of cough requiring discontinuation of ACE inhibitor therapy was 62 of 644 (9.6 per 100) patients among black subjects compared with six of 248 (2.4 per 100) patients among others (odds ratio, 4.0; 95% confidence interval, 1.7 to 9.1; p < 0.001). There were no significant differences in discontinuation rates across the three most commonly used ACE inhibitors: captopril (6.6%; all black subjects), enalapril (6.1%; 94% black subjects), and lisinopril (7.3%; 90% black subjects). Cough was more common among women (70% of subjects). After adjustment (by backward stepwise multiple logistic regression analysis) for baseline differences, black subjects had a relative risk of 2.58 (95% confidence interval, 1.21 to 4.65; p = 0.01) of discontinuation of ACE inhibitor due to cough. Conclusions These data suggest that there may be a race- or ethnicity-related difference in the prevalence of cough attributed to ACE inhibitor therapy. Although a race-related difference in ACE gene polymorphism has been suggested, further work is necessary to define the biological reason and pathophysiology for such a difference. Clinical Pharmacology doi:

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