Angiotensin Converting Enzyme Inhibitor Induced Cough :
Experience in Siriraj Hospital
PEERA BURANAKITJAROEN, MD, D.Phil*, SUTIN SRIUSSADAPORN, MD**,
META PHOOJAROENCHANACHAI, MD*, PANTIP SANGPRASERT, BSc, MNS*,
SURACHAI SARA VICH, Med. Tech*
Affiliation : * Division of Hypertension,
** Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol
University, Bangkok I 0700, Thailand.
AbstractWith the increasing use of angiotensin converting enzyme inhibitors (ACEI) in the treatment
of hypertension, particularly in diabetic patients, and heart failure, an annoying cough has frequently
been observed. According to the post marketing surveillance studies, the prevalence of cough asso
ciated with ACEI was only 0.1-4 per cent. However, many recent studies have observed a very much
higher frequency. To examine the incidence and pattern of cough associated with the usage of ACEI
(C-ACEI) in a Thai population, mixed retrospective and prospective studies were performed in hyper
tensive patients who attended the out-patient department, Siriraj Hospital between December 1999 and
August 2000. A thousand cases who had used or have been using ACEI were studied. C-ACEI was
present in 179 cases of 760 retrospective studied cases (23.6%) and 75 cases of 240 prospective studied
cases (31.3% ). Cough was typically described as irritative (93.8% retrospectively and 98.7% prospec
tively, p = 0.05) and nocturnal in onset (74.9% retrospectively and 80% prospectively, p = 0.12), and
usually appeared within the first 4 weeks of treatment (41.3% retrospectively and 46.7% prospectively,
p = 0.43). Patients who received a full dosage of ACEI did not have to posses an increasing risk of
C-ACEI. There was no difference in the prevalence of C-ACEI among types of ACEI, except cilazapril
and quinapril which were found to be higher than enalapril in the retrospective study (p < 0.0001 and
p = 0.002, respectively). Types of study were shown to influence the prevalence of C-ACEI. Prospec
tive studies yielded a higher rate of C-ACEI than retrospective ones.
Keywords : Cough, ACE Inhibitor
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