Holy Family Hospital, Bandra, Director-Cardiac Catheterization Laboratory, India.
MGM New Bombay Hospital, Mumbai, India.
Indian Heart J. 2020 Sep-Oct;72(5):345-350. doi: 10.1016/j.ihj.2020.08.007. Epub 2020 Aug 10.
Cough is one of the common adverse effects in patients receiving angiotensin-converting enzyme inhibitors (ACEIs). This review presents the current evidence on incidence and mechanisms of cough associated with ACEIs use, and proposes a practical approach for managing the same for optimal cardiovascular (CV) risk reduction. The incidence of dry cough in patients receiving ACEIs vary among individual ACEIs, and is the lowest with perindopril. Cough is thought to originate from multiple mechanisms, bradykinin theory is the most commonly appealed hypothesis. The strategies for optimal management could be temporarily discontinuation of ACEI upon a reported incidence of cough and reintroduction after its remission. However, studies have reported disappearance of cough despite continuing treatment. Another important approach could be adding calcium channel blockers to ACEIs. Switching to alternative drugs such as angiotensin receptor blockers should be suggested in case intolerable symptoms recur and after exclusion of all other possible causes of cough.
咳嗽是血管紧张素转换酶抑制剂（ACEI）治疗患者的常见不良反应之一。本文综述了 ACEI 相关咳嗽的发生率和机制的现有证据，并为降低心血管（CV）风险提出了一种实用的管理方法。接受 ACEI 治疗的患者干咳的发生率因 ACEI 个体差异而有所不同，培哚普利的发生率最低。咳嗽可能源于多种机制，缓激肽理论是最常被提及的假说。最佳管理策略可能是在报告咳嗽发生时暂时停用 ACEI，并在其缓解后重新使用。然而，研究报告称，尽管继续治疗，咳嗽仍会消失。另一种重要的方法是在 ACEI 中添加钙通道阻滞剂。如果出现无法耐受的症状并排除咳嗽的所有其他可能原因，建议换用其他药物，如血管紧张素受体阻滞剂。
