PMID: 1616218Aug 1, 1992Paper

Cough and angioneurotic edema associated with angiotensin-converting enzyme inhibitor therapy. A review of the literature and pathophysiology

Annals of Internal Medicine
Z H Israili, W D Hall


To review available information on cough and angioneurotic edema associated with angiotensin-converting enzyme (ACE) inhibitors. All relevant articles from 1966 through 1991 were identified mainly through MEDLINE search and article bibliographies. More than 400 articles were identified; 200 reporting incidence or possible mechanisms for the side effects or both were selected. All pertinent information, including incidence and mechanisms of ACE inhibitor-induced cough and angioedema, was reviewed and collated. Cough occurs in 5% to 20% of patients treated with ACE inhibitors, recurring with reintroduction of the same or another ACE inhibitor. It is more common in women. The mechanism may involve accumulation of prostaglandins, kinins (such as bradykinin), or substance P (neurotransmitter present in respiratory tract C-fibers); both bradykinin and substance P are degraded by ACE. A 4-day trial of withdrawal of the ACE inhibitor or temporary substitution of another class of antihypertensive agent inexpensively and easily ascertains if the ACE inhibitor caused the cough. Change to another ACE inhibitor or additive therapy with nonsteroidal anti-inflammatory drugs is not recommended. Prompt recognition of ACE inhibitor-related cough...Continue Reading

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