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Have you ever had a dry, tickly sensation in your throat that makes you cough and won’t go away? It could be caused by your blood pressure medication. If you already have a cough as a symptom of pulmonary hypertension (PH), you may worry about taking medications that can make your cough worse.
Angiotensin-converting enzyme (ACE) inhibitors are a group of blood pressure medications often associated with causing a cough. Here’s some background information on ACE inhibitors and other blood pressure medications that might cause coughing.
ACE inhibitors are medications used to treat hypertension (high blood pressure) and certain types of kidney disease. You might take an ACE inhibitor to treat a condition that can coexist with PH, such as left-sided heart disease or kidney disease.
ACE inhibitors’ generic names often end in “-pril.” Some examples include:
ACE inhibitors block an important step in the renin-angiotensin-aldosterone system (RAAS) — a process that regulates your blood pressure using different enzymes (a type of protein) and hormones.
Angiotensin-converting enzyme inhibitors work by blocking the enzyme responsible for turning a hormone called angiotensin 1 into angiotensin 2 (often written with Roman numerals, angiotensin I and II). Angiotensin 2 works in different parts of your body to increase your blood pressure. When you take an ACE inhibitor, there’s less angiotensin 2 in your body, resulting in lower blood pressure.
ACE inhibitors also increase the amount of a peptide (short protein chain) called bradykinin. Bradykinin lowers your blood pressure by causing your blood vessels to relax. This helps your kidneys get rid of extra salt from your blood. ACE normally breaks down bradykinin. When ACE is blocked, the amount of bradykinin in your body increases.
A cough is one of the most commonly reported side effects of all ACE inhibitors. Research findings vary as to how common the symptom is among people who take an ACE inhibitor, ranging from 1 percent to more than 30 percent.
Other possible side effects of ACE inhibitors include:
Not everyone taking an ACE inhibitor develops a cough. Researchers don’t know exactly why these medications cause coughing in some people and not others. The most commonly accepted theory is that the cough is related to an increase in irritating chemicals — such as bradykinin — that are usually broken down by the ACE enzyme. These irritating chemicals can cause the muscles in your airway to constrict.
An ACE inhibitor-induced cough may start within the first few weeks or months of starting the drug.
ACE inhibitor-induced coughing is less common in people diagnosed with high blood pressure and more common among some other groups of people. According to the European Journal of Internal Medicine, people who are at higher risk include those who are:
Some research suggests that certain genetic factors may increase the risk of developing a cough from ACE inhibitors. One meta-analysis suggested that people with a specific genetic variation, ACE gene insertion, were more likely to develop a cough after taking ACE inhibitors, especially those who were Asian or older.
Another study in the Journal of Human Hypertension that looked at Japanese people with high blood pressure found that having certain variants of the BK B2 receptors, the T or TT version, increased a person’s chance of developing a cough from ACE inhibitors, especially in women. However, there needs to be more research to confirm a connection between genetic factors and cough from ACE inhibitors.
Some ACE inhibitors may be more or less likely to cause a cough compared to other ACE inhibitors. One study showed people taking enalapril may be more likely to develop a cough than those taking perindopril.
Most coughs go away after about three weeks — this is known as an acute cough. People with a cough caused by an ACE inhibitor or PH may have a chronic cough (persistent cough) that lasts for eight weeks or longer. Common causes of persistent cough include chronic obstructive pulmonary disease (COPD), asthma, and infection.
People with a cough caused by an ACE inhibitor usually describe it as a dry cough that doesn’t bring up any mucus. It may feel like a scratching sensation in your throat. Most people with an ACE inhibitor-induced cough have a mild to moderate cough.
While a pulmonary hypertension cough can be dry, you may have additional symptoms of pulmonary hypertension, such as:
A myPHteam member described their symptoms this way: “I was hoarse like a person recovering from laryngitis at the end of each day. It was from the constant cough.”
Another member commented, “My voice isn’t hoarse. It’s more like I need to clear it, but can’t.”
The treatment for your cough depends on how severe it is. The decision to stop your current medication and start another should be shared with your healthcare provider. Consider how severe your cough is. ACE inhibitors are known to reduce your risk of dying from heart-related illness.
Your cough might go away without treatment. In two studies, ACE inhibitor-induced coughing stopped without treatment in 25 percent to 50 percent of people. If you have an ACE inhibitor cough, your healthcare provider will likely suggest stopping your ACE inhibitor and switching to another type of blood pressure medication. Your cough should resolve within one to four weeks, or up to three months.
ACE inhibitors are the blood pressure medications most often associated with developing a cough. Besides ACE inhibitors, which blood pressure medications cause coughing?
Angiotensin-receptor blockers (ARBs) are often the first drug recommended if you can’t tolerate an ACE inhibitor due to coughing or other side effects. ARBs work by blocking the effect of angiotensin 2 around your body. Some wonder, do ARBs cause a cough?
Switching to an ARB may not eliminate the risk of developing a cough. Even though ARBs don’t increase bradykinin like ACE inhibitors, about 3 percent of people develop a cough while taking ARBs. The rate of cough in people taking ARBs is lower than the risk in people taking ACE inhibitors.
Beta-blockers are another type of blood pressure medication. They can be used to treat many heart conditions, such as heart failure, heart attack, heart rhythm problems, and chest pain. Beta-blockers can decrease your blood pressure and heart rate by blocking the effect of the hormone epinephrine (also called adrenaline) on the heart muscle and blood vessels.
Beta-blockers may cause coughing, especially in people with other lung conditions like COPD or asthma. Talk to your doctor if you experience coughing or increased shortness of breath after starting a beta-blocker with PH.
Calcium channel blockers can be used to treat certain types of pulmonary arterial hypertension (PAH), high blood pressure, and heart rhythm problems. Calcium channel blockers work by blocking the effect of calcium on your heart and blood vessels. Calcium causes your muscles to squeeze more strongly. By blocking the effect of calcium, these medications help your heart muscle and blood vessels open, which can help lower your blood pressure.
Calcium channel blockers can cause gastroesophageal reflux disease (GERD), where acid from your stomach flows up your esophagus and into your mouth. The acid can cause a dry cough. It’s possible to have a cough from acid reflux even if you don’t feel a burning sensation. You may notice that a cough caused by calcium channel blockers may be worse after a meal.
Other medications used to treat PH may also cause coughing. If the oxygen levels in your blood are too low due to PH, you may use oxygen therapy. Sometimes, oxygen therapy can cause upper airway dryness and irritation. To prevent this side effect, make sure you use a humidifier and switch to an oxygen mask if possible.
Several kinds of medication are used to improve blood flow and treat PAH. Often, PAH treatment options involve more than one type of drug (called combination therapy). Certain medications are more likely to cause coughing than others, such as some inhaled vasodilators.
If you develop a cough during PAH treatment, it’s important to tell your doctor. They can help you determine if your cough is due to your condition or its treatment. If your medication is the cause, a healthcare professional may suggest adjusting your treatment plan to better manage your cough.
On myPHteam, people share their experiences with pulmonary hypertension, get advice, and find support from others who understand.
Have you experienced coughing as a side effect of your blood pressure medication? How has it affected your quality of life? Let others know in the comments below.
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I've Been Experiencing Tightness And Heaviness In My Chest Quite Often! Could It Be Oxygen Toxicity Or Symptoms Of Pulmonary Hypertension?
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