Angiotensin converting enzyme cough

Tenenbaum, A., et al. (2000). Intermediate, but not low, doses of aspirin can suppress angiotensin-converting enzyme inhibitor-induced cough, Am. J. Hypertens., 13, 776-782. 

A. Although many drugs can evoke a reaction such as a rash, a rash and a dry cough are well-recognized side effects of angiotensin converting enzyme... 

Potentially as effective as or more effective than angiotensin-converting enzyme inhibitors, without cough no evidence yet for reduction in morbidity and mortality as first-line agents in hypertension whether they provide the same cardiac and renal protection also still tentative like ACE inhibitors, less effective in black patients... 

Captopril, many others Inhibit angiotensin converting enzyme Reduce angiotensin II levels reduce vasoconstriction and aldosterone secretion increase bradykinin Hypertension heart failure, diabetes Oral Toxicity Cough, angioedema teratogenic... 

ACE inhibitors prevent the formation of angiotensin II by angiotensin-converting enzyme (ACE) and thereby reduce peripheral vascular resistance and blood pressure. In addition, ACE inhibitors prevent the effect of angiotensin II on protein synthesis in myocardial and vascular muscle cells, and thus diminish ventricular hypertrophy. As adverse effects, ACE inhibitors may provoke dry cough, impaired renal function, and hyperkalemia. When ACE inhibitors are poorly tolerated, an ATq-receptor antagonist can be given. 

The doctor decides to prescribe Sam an angiotensin-converting enzyme (ACE) inhibitor, captopril. However, a few weeks later Sam is back, complaining about his throat and a dry, hacking cough, which disrupts his business discussions and, worse,... 

Oparil S. Eprosartan versus enalapril in hypertensive patients with angiotensin-converting enzyme inhibitor-induced cough. Curr Ther Res Clin Exp 1999 60 1-4. 

Lindgren BR, Andersson RG. Angiotensin-converting enzyme inhibitors and their influence on inflammation, bronchial reactivity and cough. A research review. Med Toxicol Adverse Drug Exp 1989 4(5) 369-80. 

Fogari R, Zoppi A, Tettamanti F, Malamani GD, Tinelli C, Salvetti A. Effects of nifedipine and indometha-cin on cough induced by angiotensin-converting enzyme inhibitors a double-blind, randomized, cross-over study. J Cardiovasc Pharmacol 1992 19(5) 670-3. 

Zee RY, Rao VS, Paster RZ, Sweet CS, Lindpaintner K. Three candidate genes and angiotensin-converting enzyme inhibitor-related cough a pharmacogenetic analysis. Hypertension 1998 31(4) 925-8. 

IsraUi ZH, Hall WD. Cough and angioneurotic edema associated with angiotensin-converting enzyme inhibitor therapy. A review of the literature and pathophysiology. Ann Intern Med 1992 117(3) 234-42. 

Mukae S, Aoki S, Itoh S, Iwata T, Ueda H, Katagiri T. Bradykinin B(2) receptor gene polymorphism is associated with angiotensin-converting enzyme inhibitor-related cough. Hypertension 2000 36(1) 127-31. 

Hargreaves MR, Benson MK. Inhaled sodium cromo-glycate in angiotensin-converting enzyme inhibitor cough. Lancet 1995 345(8941) 13-16. 

ACE-I block the conversion of angiotensin 1 to angiotensin II, which causes vasoconstriction and stimulates the production of aldosterone synthesis. Thus, ACE-1 promote vasodilatation and decrease sodium retention, consequently lowering blood pressure. The inhibition of angiotensin-converting enzymes also blocks the breakdown of bradykinins. The increase in bradykinin level leads to additional vasodilatation effects. However, the increase in bradykinin is also responsible for adverse effects such as cough and angioedema. 

Adverse drug reactions drugs that can produce cough as a side-effect include angiotensin-converting enzyme inhibitors, non-steroidal anti-inflammatory drugs and beta-blockers. 

Sebastian JL, McKinney WP, Kaufman J, et al. Angiotensin-converting enzyme inhibitors and cough Prevalence in an outpatient medical chnic population. Chest 1991 99 36-39. 

Kaufman J, Casanova JE, Riendl P, et al. Bronchial hyperreactivity and cough due to angiotensin-converting enzyme inhibitors. Chest 1989 95 544-548. 

Malini PL, Strocchi E, Zanardi M, et al. Thromboxane antagonism and cough induced by angiotensin-converting enzyme inhibitor. Lancet 1997 350 15-18. 

Angiotensin-converting enzyme (ACE) ACE inhibitors e.g., enalapiil) Renoprotective effects, hypotension, left ventricular mass reduction, cough... 

Figure 11-4. Actions of angiotensin-converting enzyme inhibitors and AT receptor blockers. The enzyme is responsible for activating angiotensin by conversion of angiotensin I to angiotensin II and for inactivating bradykinin, a vasodilator normally present in very low concentrations. Block of the enzyme thus decreases the concentration of a vasoconstrictor and increases the concentration of a vasodilator. The AT, receptor antagonists lack the effect on bradykinin levels, which may explain the lower incidence of cough observed with these agents.

Angiotensin-converting enzyme inhibitor prototype used in HTN, diabetic nephropathy, and CHF. Tox hyperkalemia, fetal renal damage, cough ( sore throat ). Other prils benzepril, enalapril. lisinopril, quinapril. 

Morice AH, Lowry R, Brown MJ, Higenbottam T (1987) Angiotensin-converting enzyme and the cough reflex. Lancet 2 1116-1118... 

Dicpinigaitis PV (1996) Use of baclofen to suppress cough induced by angiotensin-converting enzyme inhibitors, Ann Pharmacother 30 1242-1245 Dicpinigaitis PV, Dobkin JB (1997) Antitussive effect of the GABA-agonist baclofen. Chest 111 996-999... 

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