Angiotensin converting enzyme inhibitors related cough and associated medications

Introduction: Angiotensin-converting enzyme inhibitors (ACEi) are among the main anti-hypertensive medications. While they are generally well tolerated, dry cough is one of their important side effects, with a frequency of up to 10 percent. Medications that are associated with increased ACEi-related cough frequency are not well described. We wanted to evaluate medications that might have an effect on ACEi-related cough. Methods: This study was designed as a post-hoc analysis of our previously published study. Patients who were on ACEi were identified, and demographics, comorbidities, laboratory data, and medications were retrieved via electronic medical records. Patients who reported cough and whose cough ceased after ACEi withdrawal were defined as having an "ACEi-related cough." Patients were grouped according to their ACEi-related cough presence. Results: One hundred and twenty-one patients were included in the study, of whom 14 experienced ACEi-related coughs. All medications except for low-dose acetylsalicylic acid (ASA) and calcium channel blockers (CCB) were similar between the groups. Low-dose ASA use was significantly higher among patients who experienced ACEi-related cough (50% vs. 16.8%, p = 0.04). On the other hand, CCB use was associated with lower ACEi-related cough (7.7% vs. 35.5%, p = 0.03). Medications other than ASA and CCB, demographics, comorbidities, and laboratory data were similar across the groups. Discussion: ACEi-related cough risk is higher among patients on low-dose ASA and lower among patients on CCB. Further studies are needed to demonstrate if there is a “safe” acetylsalicylic acid dose that is not associated with ACEi-related cough.