Name of article: Rate of Cough During Treatment with Angiotensin-Converting Enzyme Inhibitors: A Meta-Analysis of Randomized Placebo Controlled Trials

Journal: Clinical Pharmacology and Therapeutics

Year: 2019

Authors: Vukadinovic et al.

Type of article: Meta-analysis

The meta-analysis assessed 65,054 patients from 22 different trials to determine what the rate of ACEI induced cough is, versus other causes of cough in the placebo groups. The purpose of the study was to see if people were being taken off ACEI unnecessarily since ACEI are known to be beneficial for different cardiovascular conditions. They evaluated people with arterial hypertension, CHF, and coronary disease. Rates of cough with placebo were different for each group. They found that incidence of cough ranged from 3.6-37%. After adjusting by the placebo rate, they found that approximately 63% of coughs in those taking ACEI may be from causes other than the medication. 37% or about a third of coughs were attributed solely to ACEIs with the highest rate in the HTN group which the researchers determined further proves that other cardiac conditions are likely to cause a cough with or without an ACEI.

The proposed mechanism for ACEI cough is stimulation of vagal nerve by accumulation of bradykinin.

The authors propose that patients be rechallenged with ACEI after stopping to determine if the cough was solely caused by the ACEI.

Limitations mentioned in the article: There is likely an underreporting of comorbidities such as pulmonary conditions. The populations in the trials also may not match the ones in clinical practice. In addition, they do not have data from the trials to show that cough resolved after stopping the ACEI which would confirm the statistical data.