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Question clinique
What percentage of cough that develops in patients taking angiotensin-converting enzyme inhibitors is actually due to the medication?
L’Essentiel
Cough is a well-known side effect of treatment with an angiotensin-converting enzyme inhibitor (ACE-I). It's also a well-known occurrence in people not treated with an ACE-I. These researchers extrapolated from placebo-controlled trials and found approximately two-thirds of coughs that develop in patients taking an ACE-I could be attributed to causes other than the ACE-I. 1a-
Référence
Plan de l'etude: Meta-analysis (randomized controlled trials)
Financement: Self-funded or unfunded
Cadre: Various (meta-analysis)
Sommaire
These researchers conducted this meta-analysis following PRISMA guidelines. They searched 2 databases, including the Cochrane Library, identifying 22 studies of 65,054 patients treated with an ACE-I for hypertension, heart disease, or heart failure. They also searched reference lists of reviews and other meta-analyses. Two authors selected articles and abstracted the data. All studies were of high quality. Approximately 1 in 8 patients (13.5%) who were using an ACE-I reported cough as compared with 1 in 12 (8.5%) taking a placebo. Comparing these rates, approximately 63% of cough in patients taking an ACE-I were not caused by the use of the medication but by the development of spontaneous cough in the general population. Even in patients who discontinued taking an ACE-I in clinical trials because of cough, 1 in 5 (22%) cases could be attributed to spontaneous cough. ACE-I–attributed cough is lowest in patients with heart failure. There was significant heterogeneity among the study results, as well as significant risk for publication bias, possibly reflecting under-reporting of smaller studies with little difference in cough between placebo and ACE-I.
Reviewer
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA