Antihypertensive Drugs Cause Cough: Why And How To Handle?

In particular, if the patient is prescribed by a doctor to use one of the following 3 drug groups, there may be side effects (TDP) called a dry cough.
The first drug belongs to the group of ACE inhibitors, including: captopril, enalapril, benazepril, lisinopril ... The mechanism of the drug is to inhibit an enzyme called angiotensin converting enzyme (angiotensin converting enzyme, abbreviated ACE)

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It is the ACE that catalyzes the biological substance in the body, angiotensin I, to turn into angiotesin II, and the latter causes vasoconstriction to increase blood pressure. If ACE is inhibited, which is inactive, will not produce angiotensin II, vasodilation phenomenon and lowers blood pressure.
ACE inhibitors cause a dry cough because ACE not only catalyzes the conversion of angiotensin I to angiotensin II, but also plays a role in the breakdown of another biological substance called bradykinin, if ACE inhibitors, bradykinin is not degraded at Excessive will cause cough irritation in the respiratory tract
ACE inhibitors can cause a dry and persistent cough in 5 to 35% of patients taking this medication.



This is a medication for hypertension that causes a significant cough, regardless of the dose (ie, taking low doses is still) and often makes patients quit smoking.
The second drug that can cause a dry cough belongs to the group of beta-blockers, including: propranolol, pindolol, nadolol, timolol, metoprolol, atenolol, etc. heart and hypotension.
The majority of beta-blockers not only inhibit selective beta-1 receptors acting on the heart, but also inhibit beta-2 receptors causing bronchospasm. Therefore, many beta-blockers in addition to lowering blood pressure can cause cough reflexes (due to bronchospasm, note that people with asthma should also not use beta-blockers). The rate of coughing due to beta blockers is less than that of ACE inhibitors.
The third group of drugs that can cause dry cough is calcium channel blockers (also called calcium antagonists), including: nifedipine, nicardipine, amlodipine, felidipine, isradipine, verapamil, diltiazem .



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The mechanism of the drug is to block calcium ion flow from entering smooth muscle cells of the blood vessels causing vasodilation and thereby lowering blood pressure.
The mechanism of coughing in this class of drugs is not known clearly. The rate of coughing due to calcium blockers is very low, about 1 - 6%. In particular, this is a drug often combined with an ACE inhibitor, so the cough reflex is caused by a combination drug and not by a calcium channel blocker.
For people taking medication for hypertension when coughing should note the following:
Coughing can be caused by a medicine but can also be caused by another, such as a cold. In case of severe coughing, you can use normal cough medicine for a few days, if after a few days the cough does not get better, you should go to a doctor who checked for hypertension before.
Do not arbitrarily quit taking medication for hypertension (people with hypertension need to take medication regularly to control, if stopping taking blood pressure medication is so dangerous).




- If the doctor determines that a cough due to medication will replace the ACE inhibitors currently used to cause cough with a new drug called angiotesin II receptor antagonist (such as losartan, valsartan, irbesaetan, candesartan ...). Or the patient is coughing with beta-blockers, the doctor will replace the drug using selective beta-1 blockers (such as atenolol, metoprolol, bisoprolol ...) and give the lowest effective dose.




For calcium channel blockers that cause coughing, sometimes doctors replace them with other appropriate medications. In addition to medication replacement, doctors also take measures to reduce the potential factors that stimulate the cough reflex in the respiratory tract..

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