Which blood pressure medications cause coughing?
Angiotensin-converting enzyme (ACE) inhibitors are a class of prescription blood pressure medications that commonly cause coughing as a side effect. Available medications in this class include:
- Lotensin (benazepril)
- Vasotec (enalapril)
- Prinivil (lisinopril)
- Accupril (quinapril)
- Altace (ramipril)
ACE inhibitors can cause a dry, tickly cough in 4% to 35% of people who take them. The cough can start any time during treatment with an ACE inhibitor. It may start after the first dose, or it may take weeks or months. The cough usually goes away within 1 to 4 weeks after stopping an ACE inhibitor, but it can take up to 3 months.
Cough may be more likely to develop in women, and according to an observational study published in 2019 in the journal Cureus, people who are over 65 years of age and those taking cholesterol-lowering drugs may also be more likely to experience cough.
One way ACE inhibitors may cause a cough is through the actions of two compounds: bradykinin and substance P. Bradykinin and substance P cause tightening of the smooth muscle in the lungs, which leads to coughing. Blocking ACE (by taking an ACE inhibitor) allows bradykinin and substance P to build up in the lungs, which can lead to coughing.
If you’re bothered by a cough while taking an ACE inhibitor, talk with your health care provider. There may be other medicines you can take instead. Never stop taking any medicine on your own.
How ACE inhibitors work
ACE inhibitors lower blood pressure by blocking angiotensin-converting enzyme. Angiotensin-converting enzyme (ACE) converts a hormone known as angiotensin I to angiotensin II. Angiotensin II has several effects on the cardiovascular system.
- The constriction of blood vessels, which increases blood pressure and makes the heart work harder.
- The release of aldosterone, a hormone that causes sodium to be reabsorbed. Increased sodium in the body leads to increased blood pressure.
- Hypertrophy, or thickening, of the walls of blood vessels and heart tissue, which contributes to heart failure.
Blocking ACE leads to lower blood pressure. It also decreases harmful changes that can happen to the heart, known as cardiac remodeling. For that reason, ACE inhibitors are also prescribed to treat and prevent heart failure.
- Yılmaz İ. Angiotensin-Converting Enzyme Inhibitors Induce Cough. Turk Thorac J. 2019 Jan 1;20(1):36-42. https://doi.org/10.5152/turkthoracj.2018.18014.
- AARP. Do You Have a Cough that Won’t Go Away? Available at: https://www.aarp.org/health/drugs-supplements/info-02-2013/chronic-cough-ace-inhibitors.html. [Accessed February 8, 2022].
- Dicpinigaitis PV. Angiotensin-converting enzyme inhibitor-induced cough: ACCP evidence-based clinical practice guidelines. Chest. 2006 Jan;129(1 Suppl):169S-173S. https://doi.org/10.1378/chest.129.1_suppl.169S.
- Jamshed F, Jaffry HA, Hanif H, et al. Demographic and Clinical Characteristics of Patients Presenting With Angiotensin-converting Enzyme Inhibitors Induced Cough. Cureus. 2019;11(9):e5624. doi:10.7759/cureus.5624. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6822917/pdf/cureus-0011-00000005624.pdf
- U.S. Food and Drug Administration (FDA). Angiotensin-Converting Enzyme Inhibitor (ACE inhibitor) Drugs. July 8, 2015. Available at: https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/angiotensin-converting-enzyme-inhibitor-ace-inhibitor-drugs. [Accessed February 2, 2022].
- U.S. National Library of Medicine Bookshelf. Angiotensin Converting Enzyme Inhibitors (ACEI). StatPearls. 2022. Available at: https://www.ncbi.nlm.nih.gov/books/NBK431051/. [Accessed February 8, 2022].
- U.S. National Library of Medicine Bookshelf. ACE Inhibitors. StatPearls. 2022. Available at: https://www.ncbi.nlm.nih.gov/books/NBK430896/. [Accessed February 8, 2022].
- U.S. National Library of Medicine Bookshelf. Physiology, Aldosterone. StatPearls. 2022. Available at: https://www.ncbi.nlm.nih.gov/books/NBK470339/. [Accessed February 8, 2022].
- Azevedo PS, Polegato BF, Minicucci MF, Paiva SA, Zornoff LAM. Cardiac Remodeling: Concepts, Clinical Impact, Pathophysiological Mechanisms and Pharmacologic Treatment. Arq Bras Cardiol. 2016;106(1):62-69. http://dx.doi.org/10.5935/abc.20160005.
- Broadley KJ, Blair AE, Kidd EJ, Bugert JJ, Ford WR. Bradykinin-induced lung inflammation and bronchoconstriction: role in parainfluenze-3 virus-induced inflammation and airway hyperreactivity. J Pharmacol Exp Ther. 2010;335(3):681-692. https://doi.org/10.1124/jpet.110.171876
- Najafian B, Shohrati M, Harandi AA, Mahyar S, Khaheshi I, Ghanei M. Serum level of substance P in patients with lung injuries due to sulfur mustard. Adv Biomed Res. 2014;3:137. Published 2014 Jun 25. doi:10.4103/2277-9175.135154. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4139982/
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