ACE-INHIBITORS, ANGIOTENSIN-II ANTAGONISTS AND COUGH

One hundred and thirty five non-smoking hypertensive patients with ACE inhibitor cough confirmed by lisinopril rechallenge and placebo decha llenge were recruited into a double-blind random parallel-group compar ison of losartan 50 mg, lisinopril 20 mg and hydrochlorothiazide 25 mg each given once daily for a maximum of 8 weeks. The aim of the study was to compare the incidence of cough with the angiotensin II antagoni st losartan, the ACE inhibitor lisinopril and the hydrochlorothiazide in hypertensive patients with previous ACE inhibitor cough. Cough dete cted by self-administered questionnaire was the primary end-point, and cough frequency by visual analogue scale a secondary end-point, The i ncidence of cough with losartan (29%) was lower than that for lisinopr il (72%, P<0.01) and similar to that for hydrochlorothiazide (34%), Co ugh frequency by visual analogue scale was lower for losartan than lis inopril (P<0.01) and similar to that for hydrochlorothiazide. The spec ific selective AT, angiotensin II receptor antagonist losartan is sign ificantly less likely than lisinopril to cause cough in patients who p reviously have had ACE inhibitor cough. ACE inhibitor cough is likely to be related to non-specific kininase II inhibition.