A common side effect of ACE inhibitors and how is it managed?

A common side effect of ACE inhibitors and how is it managed?

• A. Cough due to bradykinin accumulation; switch to ARB if bothersome
• B. No adjustment needed; continue ACE inhibitor
• C. Lower the dose to avoid cough
• D. Switch to a calcium channel blocker

Answer: (A)

ACE inhibitors can cause a dry, persistent cough because they raise levels of bradykinin in the airway. Bradykinin helps trigger the cough reflex, so when its breakdown is inhibited, more bradykinin accumulates and can irritate the throat and airways. If the cough is bothersome, the best management is to switch to an ARB. ARBs block the angiotensin II receptor like ACE inhibitors do, but they don’t increase bradykinin, so the cough typically improves after the switch. In short, the cough is a bradykinin-driven side effect of ACE inhibitors, and switching to an ARB is the most effective way to relieve it. Lowering the dose or continuing the ACE inhibitor won’t reliably stop the cough, and switching to a calcium channel blocker doesn’t address the underlying mechanism.

ACE inhibitors can cause a dry, persistent cough because they raise levels of bradykinin in the airway. Bradykinin helps trigger the cough reflex, so when its breakdown is inhibited, more bradykinin accumulates and can irritate the throat and airways.

If the cough is bothersome, the best management is to switch to an ARB. ARBs block the angiotensin II receptor like ACE inhibitors do, but they don’t increase bradykinin, so the cough typically improves after the switch.

In short, the cough is a bradykinin-driven side effect of ACE inhibitors, and switching to an ARB is the most effective way to relieve it. Lowering the dose or continuing the ACE inhibitor won’t reliably stop the cough, and switching to a calcium channel blocker doesn’t address the underlying mechanism.