Two-thirds of coughs developing in patients using an ACE-inhibitor may not be due to the medication

Reference

Vukadinovic D, Vukadinovic AN, Laval D, Laufs U, Wagenpfeil S, Bohm M. Rate of cough during treatment with angiotensin-converting enzyme inhibitors: a meta-analysis of randomized placebo controlled trials. Clin Pharmacol Ther 2019;105(3):652-660.

Synopsis

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.