ASSOCIATION BETWEEN COUGH AND ANGIOTENSIN-CONVERTING ENZYME-INHIBITORS VERSUS ANGIOTENSIN-II ANTAGONISTS - THE DESIGN OF A PROSPECTIVE, CONTROLLED-STUDY

Background: A common adverse experience in hypertensive patients treat ed with angiotensin converting enzyme (ACE) inhibitors is a tickling d ry cough. Objectives: The aim of the present study was to review clini cal observations and mechanisms of cough associated with ACE inhibitor s. In addition, since the AT(1)-type angiotensin II antagonists (repre sented by losartan, MK 954, DuP 753) are not expected to influence oth er systems (kinins, prostaglandins) affected by ACE inhibitors, we exp lored the hypothesis that antihypertensive therapy with these agents w ill not be associated with cough at a similar frequency or quality to that seen with ACE inhibitors. Design and methods: Patients with a his tory of an ACE inhibitor-associated dry cough confirmed by a second ch allenge with lisinopril were enrolled into an international, multicent er, randomly allocated, double-blind, parallel-group, controlled trial , to be treated with losartan, lisinopril or hydrochlorothiazide. The presence and severity of cough were assessed by a self-administered qu estionnaire and a visual analog scale, respectively. Conclusions: It i s expected that the new class of antihypertensive agents, angiotensin II antagonists, will not be associated with the high incidence of dry cough associated with the use of ACE inhibitors. It appears that this cough is not related to alterations in the renin-angiotensin system bu t to kininase II effects.