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)
• Trandolapril
• Captopril
• Moexipril
• Perindopril
• Fosinopril

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.

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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.

It causes:

• 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.