lisinopril and Cough

We prospectively evaluated the antihypertensive effect and tolerability of three different antihypertensive agents, losartan (angiotensin II receptor blocker), amlodipine (calcium channel blocker), and lisinopril (angiotensin-coverting enzyme inhibitor), in patients with mild-to-moderate hypertension. After a 2-week washout period, 121 patients were randomly allocated to three different groups for 12 weeks. Medications were titrated upward as necessary to achieve the goal office-recorded sitting diastolic blood pressure (SiDBP) (defined as SiDBP <90 mmHg or SiDBP > or = 900 mmHg but with a > or = 10 mmHg drop from baseline). Efficacy and tolerability were assessed after 4, 8, and 12 weeks of therapy with each regimen. At 12 weeks, significant differences in SiDBP compared with data of baseline were noted in all three groups ( P < 0.001 in all comparisons). Similarly, significant differences in the sitting systolic blood pressure compared with baseline data were also seen for all three groups ( P < 0.001 in all comparisons). The number of patients reaching goal SiDBP were comparable for the three groups: 25 patients (62.5%) in the losartan group, 27 patients (67.5%) in the amlodipine group, and 22 patients (59.5%) in the lisinopril group (not significant). Amlodipine produced a more pronounced reduction in SiDBP than the other two medications, although without statistical significance. Patients receiving lisinopril showed a high incidence of coughing (31.7%). Low leg edema was noted only in the amlodipine group (7.5%). Compared with the amlodipine and lisinopril groups, the losartan group seemed to have relatively fewer episodes (7.5%), and fewer patients (three cases) experienced adverse effects. In conclusion, this study demonstrates that losartan has the same antihypertensive effect, but has superior tolerability compared with the other two drugs. Coughing was a common side effect of lisinopril therapy in our population.

Topics: Aged; Amlodipine; Angiotensin-Converting Enzyme Inhibitors; Antihypertensive Agents; Blood Pressure; Calcium Channel Blockers; Cough; Female; Humans; Lisinopril; Losartan; Male; Middle Aged; Prospective Studies

Dry cough is a troublesome side-effect associated with certain antihypertensive agents that act by modulating aspects of the renin-angiotensin-aldosterone system. The incidence of dry cough associated with two of these therapies, the novel All receptor antagonist telmisartan and the ACE inhibitor lisinopril, was assessed in a multicentre, randomised, parallel-group, double-blind, placebo-controlled, 8-week study of 88 patients with mild to moderate hypertension who previously demonstrated ACE inhibitor-related cough. Patients received either telmisartan 80 mg, lisinopril 20 mg, or placebo once daily. Cough incidence, measured at each visit by a self-administered symptom assessment questionnaire, was significantly higher with lisinopril (60%) than with telmisartan (15.6%) or placebo (9.7%). A visual analogue scale demonstrated a similar trend for cough frequency. Thus the incidence of cough with telmisartan 80 mg is significantly less than that seen with lisinopril 20 mg and is comparable to placebo.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Angiotensin-Converting Enzyme Inhibitors; Antihypertensive Agents; Benzimidazoles; Benzoates; Cough; Double-Blind Method; Female; Humans; Lisinopril; Male; Middle Aged; Placebo Effect; Renin-Angiotensin System; Telmisartan

In this study, telmisartan, a new angiotensin AT ( 1 ) receptor antagonist given as monotherapy and in combination with hydrochlorothiazide (HCTZ), was compared with lisinopril as monotherapy and in combination with HCTZ. This 52-week, randomized, multicenter, double-blind, double-dummy, parallel-group, dose-titration study of 578 patients with mild-to-moderate essential hypertension (mean diastolic blood pressure [DBP], >/=95 mm Hg), compared the efficacy and safety of telmisartan (n = 385) with lisinopril (n = 193). Dosage could be increased for both telmisartan (40 --> 80 --> 160 mg) and lisinopril (10 --> 20 --> 40 mg) at each of the first 2 monthly visits if DBP control (<90 mm Hg) had not been established. Once DBP control was established, patients entered the 48-week maintenance period. During this period, the dose of the study drug was fixed, although open-label HCTZ at 12.5 mg or 25 mg was added, when needed, to regain DBP control. At the end of the titration period, DBP control was achieved on monotherapy by 67% and 63% of the telmisartan and lisinopril patients, respectively. At the end of the maintenance period, supine DBP was controlled in 83% and 87% of the telmisartan and lisinopril patients, respectively, with systolic blood pressure over DBP reductions of 23.8/16.6 mm Hg for telmisartan and 19.9/15.6 mm Hg for lisinopril. Treatment-related side effects occurred in fewer telmisartan-treated patients (28%) than in lisinopril-treated patients (40%; P =.001). Significantly fewer patients (P =.018) receiving telmisartan experienced treatment-related cough (3% v 7%), and cough led to discontinuation significantly less often (P =.007) with telmisartan treatment than with lisinopril treatment (0.3% v 3.1%). In addition, two cases of angioedema were observed, both in the lisinopril group. The selective AT (1) receptor antagonist, telmisartan, is extremely effective in the treatment of mild-to-moderate hypertension both as monotherapy and in combination with HCTZ and is at least comparable in efficacy to lisinopril, with a tolerability profile that may offer advantages in terms of a reduced incidence of adverse events.

Topics: Angioedema; Angiotensin-Converting Enzyme Inhibitors; Antihypertensive Agents; Benzimidazoles; Benzoates; Blood Pressure; Cough; Double-Blind Method; Drug Therapy, Combination; Female; Humans; Hydrochlorothiazide; Hypertension; Lisinopril; Male; Middle Aged; Patient Dropouts; Telmisartan; Time Factors

The present study compares the occurrence of a dry, persistent cough with doses of 80 mg of valsartan, 10 mg of lisinopril, or 25 mg of hydrochlorothiazide in patients with a history of angiotensin-converting enzyme inhibitor-induced cough. This was a randomized, double-blind, active-controlled, parallel group, multicenter trial involving 129 adult outpatients with essential hypertension. After confirmation of angiotensin-converting enzyme inhibitor-induced cough during a 2 to 4 week challenge with lisinopril (followed by a washout period of 2 weeks), patients were randomized to receive 6 weeks of double-blind treatment once daily with 80 mg valsartan, 10 mg lisinopril, or 25 mg hydrochlorothiazide. Assessments were made at baseline and after 3 and 6 weeks of treatment. Comparability of response to treatment was assessed by mean sitting diastolic and systolic blood pressure at the end of treatment. The occurrence of a dry, persistent cough was significantly less (P < 0.001) at 3 and 6 weeks with valsartan (19.5%) than with lisinopril (68.9%), with no significant difference between valsartan and hydrochlorothiazide (19.0%). There were no statistically significant differences in reduction of blood pressure among the three treatment groups. The overall incidence of adverse experiences, whether or not treatment-related, was highest for lisinopril (86.7%) compared with valsartan (57.1%), and hydrochlorothiazide (61.9%). A dry cough in the lisinopril group accounted for this difference. There were no clinically significant changes in physical signs or in results of clinical laboratory evaluations during double-blind treatment, except for from metabolic changes in 3 patients receiving hydrochlorothiazide. In hypertensive patients with a history of angiotensin-converting enzyme inhibitor-induced cough, a single daily dose of 80 mg of valsartan produced therapeutic efficacy comparable to lisinopril but with significantly less cough.

Topics: Angiotensin Receptor Antagonists; Angiotensin-Converting Enzyme Inhibitors; Antihypertensive Agents; Cough; Double-Blind Method; Female; Humans; Hydrochlorothiazide; Hypertension; Lisinopril; Male; Middle Aged; Tetrazoles; Valine; Valsartan

This study compared the incidence of cough with the angiotensin-converting enzyme (ACE) inhibitor lisinopril and the diuretic metolazone with angiotensin II receptor antagonist losartan in elderly hypertensive patients with previous histories of ACE inhibitor-induced cough. A randomized, double-blind, stratified, parallel-group comparison of lisinopril at 10 mg, losartan at 50 mg, and metolazone at 1 mg, each given once daily for a maximum of 10 weeks, was performed in four hypertension clinics in four centers in two countries. Cough was detected by a questionnaire (the primary end point) given to elderly patients with hypertension, and the cough frequency was quantified by a visual analog scale (a secondary end point). A total of 84 elderly patients with hypertension, all who were nonsmokers with ACe inhibitor-induced cough and were confirmed by lisinopril rechallenge then placebo dechallenge, were randomized to the three treatment groups. The incidence of cough with losartan (18%) was significantly lower than with lisinopril (97%) and similar to that for metolazone (21%). Cough frequency evaluated by the visual analog scale was significantly lower for losartan than for lisinopril and similar to that for metolazone. The specific, selective angiotensin II receptor antagonist losartan is associated with a decrease in the incidence of cough in patients with previous ACE inhibitor-induced cough.

Topics: Aged; Aged, 80 and over; Angiotensin-Converting Enzyme Inhibitors; Antihypertensive Agents; Benzothiadiazines; Biphenyl Compounds; Cough; Diuretics; Double-Blind Method; Female; Humans; Hypertension; Imidazoles; Lisinopril; Losartan; Male; Metolazone; Sodium Chloride Symporter Inhibitors; Surveys and Questionnaires; Tetrazoles

To compare the incidence of cough with the angiotensin II antagonist losartan, the angiotensin converting enzyme inhibitor lisinopril, and hydrochlorothiazide in hypertensive patients with previous angiotensin converting enzyme inhibitor cough.. Double-blind random stratified parallel-group comparison of losartan 50 mg, lisinopril 20 mg and hydrochlorothiazide 25 mg, each given once daily for a maximum of 8 weeks. Cough detected by self-administered questionnaire (the primary end-point) and cough frequency by visual analogue scale (a secondary end-point).. Hypertension clinics in 20 centres in 11 countries.. 135 hypertensive patients, all non-smokers, with angiotensin converting enzyme inhibitor cough confirmed by lisinopril rechallenge then placebo dechallenge.. Incidence of cough with losartan (29%) lower than that for lisinopril (72%; P < 0.01) and similar to that for hydrochlorothiazide (34%). Cough frequency by visual analogue scale lower for losartan than lisinopril (P < 0.01) and similar to that for hydrochlorothiazide.. The specific selective angiotensin II receptor (AT1) antagonist losartan does not cause cough in patients with previous angiotensin converting enzyme inhibitor cough. Angiotensin converting enzyme inhibitor cough is likely to be related to kininase II inhibiting action.

Topics: Angiotensin II Type 1 Receptor Blockers; Angiotensin-Converting Enzyme Inhibitors; Cough; Diuretics; Double-Blind Method; Female; Humans; Hydrochlorothiazide; Hypertension; Incidence; Lisinopril; Losartan; Male; Middle Aged; Pain Measurement

One hundred and thirty five non-smoking hypertensive patients with ACE inhibitor cough confirmed by lisinopril rechallenge and placebo dechallenge were recruited into a double-blind random parallel-group comparison of losartan 50 mg, lisinopril 20 mg and hydrochlorothiazide 25 mg each given once daily for a maximum of 8 weeks. The aim of the study was to compare the incidence of cough with the angiotensin II antagonist losartan, the ACE inhibitor lisinopril and the hydrochlorothiazide in hypertensive patients with previous ACE inhibitor cough. Cough detected by self-administered questionnaire was the primary end-point, and cough frequency by visual analogue scale a secondary end-point. The incidence of cough with losartan (29%) was lower than that for lisinopril (72%, P < 0.01) and similar to that for hydrochlorothiazide (34%). Cough frequency by visual analogue scale was lower for losartan than lisinopril (P < 0.01) and similar to that for hydrochlorothiazide. The specific selective AT1 angiotensin II receptor antagonist losartan is significantly less likely than lisinopril to cause cough in patients who previously have had ACE inhibitor cough. ACE inhibitor cough is likely to be related to non-specific kininase II inhibition.

Topics: Adult; Aged; Angiotensin-Converting Enzyme Inhibitors; Antihypertensive Agents; Biphenyl Compounds; Cough; Double-Blind Method; Female; Humans; Hydrochlorothiazide; Hypertension; Imidazoles; Lisinopril; Losartan; Male; Middle Aged; Surveys and Questionnaires; Tetrazoles

To compare the incidence of cough in patients with a history of angiotensin converting enzyme (ACE) inhibitor-related cough who received losartan [a type 1 angiotensin II (Ang II) receptor antagonist], lisinopril (an ACE inhibitor) or hydrochlorothiazide (a diuretic).. An international, multicentre, randomized double-blind, parallel-group controlled trial.. Outpatient clinics at 20 tertiary care medical centres in 11 countries.. One hundred and thirty-five patients with uncomplicated primary hypertension with a history of ACE inhibitor-related cough were randomly assigned to the double-blind treatment phase and completed the study.. After confirming that the cough was ACE inhibitor-related by a single-blind rechallenge, followed by a placebo washout period, patients were randomly assigned to receive 50mg losartan, 20mg lisinopril or 25mg hydrochlorothiazide once a day for 8 weeks.. Cough incidence, severity and frequency were assessed by a self-administered questionnaire and a visual analogue scale.. The percentage of patients who complained of cough was significantly higher with lisinopril than with losartan or hydrochlorothiazide. The mean visual analogue scale scores for patients treated with lisinopril demonstrated that these patients coughed more frequently than those who received losartan or hydrochlorothiazide.. The incidence of cough related to the type 1 Ang II receptor antagonist losartan is significantly lower than that observed with lisinopril, and similar to that observed with hydrochlorothiazide in patients with a rechallenged ACE inhibitor cough. Type 1 Ang II receptor antagonists represent a potential new treatment for hypertensive patients in whom ACE inhibitors are indicated, but who develop a cough with these agents.

Topics: Adult; Aged; Angiotensin Receptor Antagonists; Biphenyl Compounds; Cough; Double-Blind Method; Female; Humans; Hydrochlorothiazide; Hypertension; Imidazoles; Lisinopril; Losartan; Male; Middle Aged; Prospective Studies; Renin-Angiotensin System; Tetrazoles

In a double-blind double-dummy multicenter study, patients with mild to moderate essential hypertension were randomized to receive either nifedipine (n = 416, 47.6% women) or lisinopril (n = 412, 50% women), and side effects were registered by specific questioning, by spontaneous reports, and by use of visual analog scales. Cough was spontaneously reported to occur in 8.5% with lisinopril compared to 3.1% with nifedipine. Women treated with lisinopril reported cough spontaneously three times more often than men, 12.6% v 4.4%, whereas no differences between the sexes were observed during the placebo period or during nifedipine treatment. Similar gender differences were observed during specific questioning. Furthermore, nonsmokers reported an increase in cough more often than did smokers.

Topics: Adult; Aged; Cough; Double-Blind Method; Female; Humans; Hypertension; Lisinopril; Male; Middle Aged; Nifedipine; Sex Factors; Surveys and Questionnaires

A common adverse experience in hypertensive patients treated with angiotensin converting enzyme (ACE) inhibitors is a tickling dry cough.. The aim of the present study was to review clinical observations and mechanisms of cough associated with ACE inhibitors. In addition, since the AT1-type angiotensin II antagonists (represented by losartan, MK954, DuP753) are not expected to influence other systems (kinins, prostaglandins) affected by ACE inhibitors, we explored the hypothesis that antihypertensive therapy with these agents will not be associated with cough at a similar frequency or quality to that seen with ACE inhibitors.. Patients with a history of an ACE inhibitor-associated dry cough confirmed by a second challenge with lisinopril were enrolled into an international, multicenter, randomly allocated, double-blind, parallel-group, controlled trial, to be treated with losartan, lisinopril or hydrochlorothiazide. The presence and severity of cough were assessed by a self-administered questionnaire and a visual analog scale, respectively.. It is expected that the new class of antihypertensive agents, angiotensin II antagonists, will not be associated with the high incidence of dry cough associated with the use of ACE inhibitors. It appears that this cough is not related to alterations in the renin-angiotensin system but to kininase II effects.

Topics: Adult; Angiotensin II; Antihypertensive Agents; Biphenyl Compounds; Cough; Double-Blind Method; Female; Humans; Hydrochlorothiazide; Hypertension; Imidazoles; Lisinopril; Losartan; Male; Prospective Studies; Research Design; Surveys and Questionnaires; Tetrazoles

In a Norwegian, double-blind, double-dummy multicenter study, 828 patients with mild to moderate hypertension were randomized to treatment by either lisinopril or nifedipine. One of the aims of the study was to specifically investigate the frequency of side effects. Spontaneously reported coughing reached 8.5% for lisinopril, as against 3.1% for nifedipine. In two patients coughing led to withdrawal from the study, and in another three it contributed partially to discontinuation of the treatment. A significant sex difference was found for spontaneously reported coughing among patients on lisinopril; 12.6% of the women and 4.4% of the men. A similar difference between the sexes was found for specific questioning about coughing. Use of a visual analogue scale by both patient and spouse revealed similar frequency of coughing as when reported spontaneously. The reason for sex being an important determinant for lisinopril-induced coughing remains obscure.

Topics: Angiotensin-Converting Enzyme Inhibitors; Cough; Dipeptides; Double-Blind Method; Drug Evaluation; Female; Humans; Hypertension; Lisinopril; Male; Middle Aged; Nifedipine; Norway; Sex Factors

In a randomized, parallel, double-blind study, lisinopril (n = 412) reduced systolic and diastolic blood pressure more than nifedipine did (n = 416) after ten weeks treatment in patients (40-70 years) with mild to moderate essential hypertension. Lisinopril was tolerated better than nifedipine, with fewer withdrawals. Adverse experiences reported after a general question on discomfort were significantly lower for lisinopril than for nifedipine. Questions referring specifically to symptoms revealed higher frequency of coughing with lisinopril, while flushing, edema, palpitations, dizziness, tiredness and rash were reported more frequently with nifedipine. Quality of life was similarly assessed by both patients and spouses. No significant differences in well-being during treatment were found for either drug, except in the case of the highest dose level of nifedipine, which caused a deterioration of well-being.

Topics: Adult; Aged; Angiotensin-Converting Enzyme Inhibitors; Cough; Dipeptides; Double-Blind Method; Female; Humans; Hypertension; Lisinopril; Male; Middle Aged; Nifedipine; Norway; Quality of Life

Topics: Angiotensin-Converting Enzyme Inhibitors; Cough; Double-Blind Method; Enalapril; Female; Humans; Lisinopril; Male; Sex Factors

The efficacy and tolerability of combination therapy using Lisinopril (5-20 mg om) and Isradipine (1.25 mg-2.50 mg bd) was assessed in 29/50 Chinese subjects, whose blood pressures were not controlled on Isradipine alone. The addition of Lisinopril produced approximately two-fold reductions in blood pressure compared to Isradipine alone, increasing the responder rate of the original cohort of 50 subjects by 18% and normalization rate, by 32%. No significant changes in haematological or biochemical parameters, CXR or ECG, were observed. However, use of Lisinopril in our subjects was associated with a high incidence of cough (48%), possibly limiting its use in this population.

Topics: Adult; Aged; Antihypertensive Agents; Cough; Dihydropyridines; Drug Therapy, Combination; Enalapril; Female; Humans; Hypertension; Isradipine; Lisinopril; Male; Middle Aged

We have previously shown that cough potentiation induced by intravenous administration of the AT1 receptor antagonist losartan is lower than that induced by the ACE inhibitor lisinopril in anesthetized and awake rabbits. Since losartan and lisinopril cross the blood-brain barrier, their central action on the cough reflex can be hypothesized. Mechanical stimulation of the tracheobronchial tree and citric acid inhalation were used to induce cough reflex responses in pentobarbital sodium-anesthetized, spontaneously breathing rabbits. Bilateral microinjections (30-50 nl) of losartan (5mM), lisinopril (1mM), bradykinin (0.05 mM), HOE-140 (0.2mM, a bradykinin B2 receptor antagonist) and CP-99,994 (1mM, an NK1 receptor antagonist) were performed into the caudal nucleus tractus solitarii, the predominant site of termination of cough-related afferents. Lisinopril, but not losartan increased the cough number. This effect was reverted by HOE-140 or CP-99,994. Cough potentiation was also induced by bradykinin. The results support for the first time a central protussive action of lisinopril mediated by an accumulation of bradykinin and substance P.

Topics: Angiotensin-Converting Enzyme Inhibitors; Animals; Bradykinin; Bradykinin B2 Receptor Antagonists; Citric Acid; Cough; Lisinopril; Male; Microinjections; Neurokinin-1 Receptor Antagonists; Peptidyl-Dipeptidase A; Physical Stimulation; Piperidines; Rabbits; Receptor, Bradykinin B2; Receptors, Neurokinin-1; Reflex; Solitary Nucleus

The aim of the present study was to analyze differences in cough induction between losartan and lisinopril in both anaesthetized and awake rabbits, i.e., under conditions in which the influences of higher brain areas on the cough reflex are strongly reduced or abolished. Losartan (500 μg/kg), lisinopril (100 μg/kg) and NaCl 0.9% saline solution (vehicle) were administered by intravenous injections. Animals were randomly assigned to the different experimental treatments. The cough reflex was induced by chemical (citric acid) and/or mechanical stimulation of the tracheobronchial tree. In anaesthetized rabbits, losartan and lisinopril caused similar hypotensive effects. Lisinopril, but not losartan, increased the cough response induced by both mechanical and chemical stimulation due to increases in the cough number, i.e. the number of coughs induced by each stimulation challenge. In awake animals, only lisinopril significantly increased the cough number. The results support the notion that cough potentiation induced by losartan, and possibly other sartans, is lower than that induced by most angiotensin-converting enzyme inhibitors despite the reduction or complete absence of higher brain functions. In this connection, the comparison between present results and our previous findings on ramipril and zofenopril shows that losartan and zofenopril display similar cough-inducing potency, much lower than that of lisinopril and ramipril.

Topics: Administration, Inhalation; Administration, Intravenous; Anesthesia; Angiotensin II Type 1 Receptor Blockers; Angiotensin-Converting Enzyme Inhibitors; Animals; Citric Acid; Cough; Lisinopril; Losartan; Male; Physical Stimulation; Rabbits; Reflex

Few studies have examined the relationship between ethnicity and tolerance of hypertension medications. We investigated the perception that Chinese-Americans may have a higher incidence of chronic cough from angiotensin-converting enzyme inhibitors.. We searched electronic databases to identify patients who had received a new lisinopril prescription. This cohort was separated into 295 patients of Chinese descent and 4263 patients in the general population group with an instrument that used surnames to identify Chinese ethnicity. For those who discontinued lisinopril within 1 year, we reviewed medical records to determine reasons for discontinuation. We compared rates of discontinuation overall and due to cough by ethnic group (Chinese vs general population).. The Chinese population was more likely to discontinue their medication (47%) than the general population (31%). When the cause for discontinuation was examined, cough was significantly higher among Chinese, with a relative risk of 2.53; 95% confidence interval (CI), 2.11-3.03. The risk for angioedema was <1%, and no difference in the risk of angioedema was found between the 2 groups. When controlled for age, sex, and smoking, the risk of cough among Chinese-Americans remained significant (relative risk 2.63; 95% CI, 2.20-3.15).. We observed that our Chinese group was more than twice as likely as the general population to discontinue lisinopril due to cough, controlling for the influence of sex, age, and smoking.

Topics: Aged; Angiotensin-Converting Enzyme Inhibitors; Antihypertensive Agents; Asian; California; Cohort Studies; Cough; Female; Humans; Hydrochlorothiazide; Lisinopril; Male; Middle Aged; Retrospective Studies; Risk Assessment

Topics: Angiotensin-Converting Enzyme Inhibitors; Antihypertensive Agents; Cough; Heart Failure; Humans; Lisinopril; Myocardial Infarction; Tetrazoles; Valine; Valsartan

Topics: Angiotensin-Converting Enzyme Inhibitors; Bone Wires; Cardiac Surgical Procedures; Cough; Humans; Lisinopril; Sternum; Surgical Wound Dehiscence

We report two cases, which underwent surgery through Median sternotomy. They were on ACE inhibitors [corrected] pre-operatively. Both of these patients developed persistent dry cough post-operatively, which resulted in sternal wound dehiscence. They had no clinical or bacteriological evidence of sternal wound infection. Although one patient was overweight and had moderately impaired left ventricular function, there were no other associated risk factors. Both patients underwent rewiring of the sternum. Type II receptors inhibitor were introduced post-rewiring, which cured the persistent dry cough. Both the patients are enjoying a good quality of life at 2 year 6 months and 2 years post-rewiring of the sternum.

Topics: Angiotensin-Converting Enzyme Inhibitors; Cardiac Surgical Procedures; Cough; Female; Humans; Lisinopril; Male; Middle Aged; Sternum; Surgical Wound Dehiscence

Topics: Aged; Aged, 80 and over; Angiotensin Receptor Antagonists; Angiotensin-Converting Enzyme Inhibitors; Cough; Female; Humans; Lisinopril; Losartan

Cough is one of the most frequent side effects associated with angiotensin converting enzyme inhibitors (ACEIs) but is not thought to be associated with losartan, an angiotensin II receptor antagonist (ARA). This study compares reports of cough with losartan and three ACEIs used in general practice.. Studies have been conducted for losartan, and three ACEIs enalapril, lisinopril and perindopril, using the technique of Prescription-Event Monitoring. Patients were identified using dispensed prescription data. Questionnaires were sent to patients' general practitioners 6 months after the date of first prescription. Cases of cough within the first 60 days of treatment with losartan resulting in withdrawal of the drug were followed up with additional questionnaires. Incidence rates for reports of cough were calculated. In order to reduce the impact of carry-over effects, rate ratios were calculated for first reports of cough between days 8 and 60 using losartan as the index drug.. The cohort for each drug exceeded 9000 patients. Age and sex distributions and indications for prescribing the four drugs were similar. Cough was the most frequent reason for discontinuation of losartan and the most frequently reported event in the first month of treatment with this drug. When reports of cough between days 1-7 were excluded, rates of cough were significantly higher for the three ACEIs when compared with losartan (rate ratios 1.5, 4.8 and 5.7, all P<0.03). 101 patients had discontinued losartan due to cough. 91% of these had previously been prescribed an ACEI and 86% had previously experienced ACEI cough.. Carry-over accounted for the observed excess of reports of cough with losartan. Rates of cough between days 8 and 60 were significantly higher for the three ACEIs compared with losartan. Confounding factors associated with comparative observational cohort studies are discussed.

Topics: Aged; Angiotensin-Converting Enzyme Inhibitors; Cohort Studies; Confounding Factors, Epidemiologic; Cough; Data Collection; Drug Monitoring; Enalapril; Female; Humans; Indoles; Lisinopril; Losartan; Male; Middle Aged; Perindopril

Topics: Aged; Angiotensin II; Antihypertensive Agents; Cough; Female; Humans; Lisinopril; Losartan; Randomized Controlled Trials as Topic

Topics: Aged; Angiotensin-Converting Enzyme Inhibitors; Cardiotonic Agents; Chronic Disease; Cough; Humans; Lisinopril; Male

Cough is an important side effect of Angiotensin Converting Enzyme Inhibitor (ACEI) therapy. The incidence of cough was investigated in a prospective 8 week study in 250 hypertensive patients receiving ACEI alone or in combination with other agents. Enalapril (5-20 mg/day), Lisinopril (5-20 mg/day), Captopril (25-75 mg/day) or Ramipril (5-15 mg/day) was prescribed to patients, who were followed up at weekly visits. Cough developed in 73 of the 250 patients i.e. an incidence of 29.2%. Females had a higher incidence of cough as compared to males--37.9% versus 15.5% (p < 0.001) and there was no significant difference in the cough incidence in the various age groups. A dry, non-productive cough developed in all patients within 4 weeks of ACEI initiation. Increased nocturnal intensity of cough was reported by 79.4% patients. Cough incidence was 34.4%, 24.3% and 18.1% in patients on Enalapril, Ramipril and Lisinopril, respectively. Cough was not dose related and was not related to smoking. There was no statistically significant difference among patients on ACEI alone or in combination with beta blockers, calcium channel blockers or diuretics. Of the 18 patients with ACEI induced cough who received Indomethacin, 50 mg bid, 8 reported complete cure and cough was reduced in intensity in the remaining ten.

Topics: Adult; Aged; Angiotensin-Converting Enzyme Inhibitors; Captopril; Cough; Enalapril; Female; Follow-Up Studies; Humans; Hypertension; Incidence; India; Indomethacin; Lisinopril; Male; Middle Aged; Prospective Studies; Ramipril; Risk Assessment

OBJECTIVE. This study examines cough recorded in Prescription-Event Monitoring (PEM) of four ACE-inhibitors. Particular attention was paid to the study of enalapril because the drug was monitored before the causal relationship between cough and ACE-inhibitors had been widely accepted. RESULTS. Several factors which had obscured the causal relationship in the individual cases were found to be also an obstacle in PEM. For example, cough was a common and non-serious event and was under-reported in the PEM study of enalapril and the rate was not strikingly different from that recorded for other drugs. Cough induced by ACE-inhibitors has several characteristics which reduce the chance of a recognisable "signal'. The original questionnaires returned from doctors in the PEM study of enalapril have been reexamined. The observation that the rate of cough diminished after enalapril had been stopped rather than increased after starting, provided the best evidence of causality, because this was not affected by many biases such as the publicity that had occurred prior to doctors participating in PEM completed later reports.

Topics: Adult; Aged; Angiotensin-Converting Enzyme Inhibitors; Cardiovascular Agents; Cohort Studies; Cough; Enalapril; Female; Humans; Indoles; Lisinopril; Male; Middle Aged; Perindopril; Product Surveillance, Postmarketing; Ramipril; Structure-Activity Relationship; Surveys and Questionnaires

Angiotensin-converting enzyme (ACE) inhibitors are one of the first drugs of choice for the treatment of hypertension. However, there have been many reports of persistent chronic dry cough and inflammatory skin reactions (rash and/or angioedema, etc.) induced by ACE inhibitors. In this study, in order to evaluate the cough and inflammatory reaction, we measured the number of citric acid-induced coughs and the intradermal inflammation with ovalbumin in guinea pigs consecutively treated with ACE inhibitors (lisinopril, enalaprilat and imidapril) for 3 days. The number of citric acid-induced coughs and the inflammatory responses were significantly enhanced by treatment with lisinopril and enalaprilat, whereas imidapril produced no change in either response. These results correspond to the frequency of adverse effects in clinical practice, which suggests that imidapril has the least ability to induce the inflammatory skin response and cough. Furthermore, the enhancement produced by the ACE inhibitors in the number of coughs and the inflammatory responses were significantly reduced by pretreatment with indomethacin (prostaglandin synthesis inhibitor). This finding suggests that PGs at least participate in the mechanism for ACE inhibitor-induced cough and inflammatory skin response.

Topics: Angiotensin-Converting Enzyme Inhibitors; Animals; Cough; Cyclooxygenase Inhibitors; Enalaprilat; Female; Guinea Pigs; Imidazoles; Imidazolidines; Indomethacin; Inflammation; Lisinopril

Topics: Angioedema; Angiotensin-Converting Enzyme Inhibitors; Captopril; Cough; Dose-Response Relationship, Drug; Enalapril; Humans; Hypertension; Isoquinolines; Kidney Diseases; Lisinopril; Otolaryngology; Quinapril; Tetrahydroisoquinolines

1. We report a controlled retrospective cohort study of respiratory adverse reactions to ACE inhibitors. Bronchospasm and cough occurred at a higher rate in patients treated with ACE inhibitors, no links with sex, past history of bronchospasm, drug type or dose were found. 2. Cohorts of 1013 patients on angiotensin converting enzyme (ACE) inhibitors and 1017 patients on lipid lowering drugs (LLDs) were compared for the occurrence of new bronchospasm, relapse of previous bronchospasm, increase of current bronchospasm, and cough. 3. The prevalence of bronchospasm was 5.5% for patients on ACE inhibitors and 2.3% for patients on LLDs, P < 0.001. The relative risk of a bronchospasm adverse reaction for a patient on an ACE inhibitor compared with a patient on a LLD was 2.39, 95% confidence interval 1.47 to 3.90. 4. No ACE inhibitor specificity, or significant sex differences were found in the prevalence of bronchospasm or cough after correcting for bias implicit in the original cohorts. The bronchospastic reactions were not dose dependent. 5. The prevalence of a past history of bronchospasm in patients reporting ACE inhibitor-induced bronchospasm (16%) was not significantly different from the prevalence in patients on ACE inhibitors without an adverse reaction (13%), P = 0.447. 6. The prevalence of ACE inhibitor cohort cough was 12.3% and 2.7% in the patients on LLDs, P < 0.0001. Cough did not occur more commonly in patients on ACE inhibitors who had experienced any bronchospasm (28%) than in patients on LLDs with bronchospasm (27%).

Topics: Aged; Bronchial Spasm; Captopril; Chi-Square Distribution; Cohort Studies; Computer Simulation; Cough; Enalapril; Female; Humans; Hypolipidemic Agents; Lisinopril; Male; Middle Aged; Prevalence; Retrospective Studies; Sex Factors; Surveys and Questionnaires

Topics: Angiotensin-Converting Enzyme Inhibitors; Cough; Drug Industry; Humans; Lisinopril; Male; Middle Aged; Occupational Exposure

Probably the most common and irritating side effect of angiotensin-converting enzyme (ACE) inhibitors is cough. In this retrospective study the incidence of cough was investigated in 1113 patients with arterial hypertension who were receiving ACE inhibitors alone or in combination with other antihypertensive agents. Patients were treated with one of the following ACE inhibitors: enalapril 10-20 mg/day (n:668), captopril 25-75 mg/day (n:234), perindopril 2-8 mg/day (n:90), or lisinopril 5-20 mg/day (n:121). Mean follow-up periods were twenty-six months with enalapril, twenty-nine months with captopril, eleven months with perindopril, and thirteen months with lisinopril. Spontaneously declared cough incidence in enalapril, captopril, perindopril, and lisinopril groups were 7%, 5.1%, 2.2%, and 1.6%, respectively. Cough was not dose related. Treatment was stopped in all patients with cough. In 59% of patients the onset of cough occurred after the first month of treatment (thirty to one hundred eighty days). Cough decreased by 50% within three days of drug cessation and disappeared in ten days. Mean age of patients with cough was 58.7 years and 79% of them were women. In patients without cough, mean age was 57.8 years and 56% of them were women. There was no significant difference between the two groups regarding mean age, but the sex difference between groups was statistically significant (P < 0.05). In conclusion, although cough may occur with all four types of ACE inhibitors, the incidence of this side effect was higher during enalapril and captopril treatment than during lisinopril and perindopril treatment. The incidence was also greater in women than in men.

Topics: Adult; Aged; Aged, 80 and over; Angiotensin-Converting Enzyme Inhibitors; Antihypertensive Agents; Captopril; Cough; Enalapril; Female; Humans; Hypertension; Indoles; Lisinopril; Male; Middle Aged; Perindopril; Retrospective Studies

To evaluate the occurrence of asthma and dyspnoea precipitated or worsened by angiotensin converting enzyme inhibitors.. Summary of reports of adverse respiratory reaction in relation to treatment with angiotensin converting enzyme inhibitors that were submitted to Swedish Adverse Drug Reactions Advisory Committee and to World Health Organisation's international drug information system until 1992. Sales of angiotensin converting enzyme inhibitors in Sweden were also summarised.. Patients receiving angiotensin converting enzyme inhibitors who reported adverse respiratory reactions.. Clinical characteristics of adverse reactions of asthma, bronchospasm, and dyspnoea.. In Sweden 424 adverse respiratory reactions were reported, of which most (374) were coughing. However, 36 patients had adverse drug reactions diagnosed as asthma, bronchospasm, or dyspnoea. In 33 of these cases the indication for treatment with angiotensin converting enzyme inhibitors was hypertension, in only three heart failure. The respiratory symptoms occurred in about half of the patients within the first two weeks of treatment, and about one third needed hospitalisation or drug treatment. Dyspnoea symptoms occurred in conjunction with other symptoms from the airways or skin in 23 out of the 36 cases. In the WHO database there were 318 reports of asthma or bronchospasm, 516 reports of dyspnoea, and 7260 reports of cough in relation to 11 different angiotensin converting enzyme inhibitors.. Symptoms of airway obstruction in relation to treatment with angiotensin converting enzyme inhibitors seem to be a rare but potentially serious reaction generally occurring within the first few weeks of treatment.

Topics: Adult; Aged; Aged, 80 and over; Angiotensin-Converting Enzyme Inhibitors; Asthma; Bronchial Spasm; Captopril; Cough; Dyspnea; Enalapril; Female; Humans; Lisinopril; Male; Middle Aged; Ramipril

Cough is a recognised side effect of angiotensin converting enzyme (ACE) inhibitors although its exact mechanism is still unknown. Reports on the side effect of ACE inhibitors on asthma have been conflicting. These drugs either had no effect on bronchial reactivity or resulted in an increase in pre-existing hyperreactivity. We report a case of a non-asthmatic patient who had lisinopril-induced cough and bronchial hyperreactivity.

Topics: Adult; Angiotensin-Converting Enzyme Inhibitors; Antihypertensive Agents; Cough; Enalapril; Humans; Lisinopril; Male

Topics: Angiotensin-Converting Enzyme Inhibitors; Cough; Enalapril; Humans; Lisinopril

Topics: Cough; Enalapril; Humans; Lisinopril