DOUBLE-BLIND COMPARISON OF LOSARTAN, LISINOPRIL AND HYDROCHLOROTHIAZIDE IN HYPERTENSIVE PATIENTS WITH A PREVIOUS ANGIOTENSIN-CONVERTING ENZYME INHIBITOR-ASSOCIATED COUGH

Objective: To compare the incidence of cough with the angiotensin II a ntagonist losartan, the angiotensin converting enzyme inhibitor lisino pril, and hydrochlorothiazide in hypertensive patients with previous a ngiotensin converting enzyme inhibitor cough. Design: Double-blind ran dom stratified parallel-group comparison of losartan 50 mg, lisinopril 20 mg and hydrochlorothiazide 25 mg, each given once daily for a maxi mum of 8 weeks. Cough detected by self-administered questionnaire (the primary end-point) and cough frequency by visual analogue scale (a se condary end-point). Setting: Hypertension clinics in 20 centres in 11 countries. Patients: 135 hypertensive patients, all non-smokers, with angiotensin converting enzyme inhibitor cough confirmed by lisinopril rechallenge then placebo dechallenge. Results: Incidence of cough with losartan (29%) lower than that for lisinopril (72%; P < 0.01) and sim ilar to that for hydrochlorothiazide (34%). Cough frequency by visual analogue scale lower for losartan than lisinopril (P < 0.01) and simil ar to that for hydrochlorothiazide. Conclusions: The specific selectiv e angiotensin II receptor (AT(1)) antagonist losartan does not cause c ough in patients with previous angiotensin converting enzyme inhibitor cough. Angiotensin converting enzyme inhibitor cough is likely to be related to kininase II inhibiting action.