Have you ever had a dry, tickly sensation in your throat that makes you cough and won’t go away? It could be caused by your blood pressure medication. If you already have a cough as a symptom of pulmonary hypertension (PH), you may worry about taking medications that can worsen it.

Angiotensin converting enzyme (ACE) inhibitors are a group of blood pressure medications that are most often associated with causing a cough. Continue reading to learn more about ACE inhibitors and other blood pressure medications that could cause coughing.

What Are ACE Inhibitors?

ACE inhibitors are medications used to treat hypertension (high blood pressure) and kidney disease. You might take an ACE inhibitor to treat a condition related to PH — such as left-sided heart disease or kidney disease.

ACE inhibitors’ generic names often end in “-pril.” Some examples include:

• Benazepril (Lotensin)
• Captopril (Capoten)
• Enalapril (Vasotec)
• Fosinopril (Monopril)
• Lisinopril (Zestril or Prinivil)
• Moexipril (Univasc)

How Do ACE Inhibitors Work?

ACE inhibitors block an important step in the renin-angiotensin-aldosterone system (RAAS) — a process that regulates your blood pressure using different enzymes (a type of protein) and hormones.

As the full name suggests, angiotensin converting enzyme inhibitors work by blocking the angiotensin converting enzyme from turning a hormone called angiotensin I (1) into angiotensin II (2). Angiotensin II works in different parts of your body to increase your blood pressure. When you take an ACE inhibitor, there’s less angiotensin II in your body, resulting in lower blood pressure.

ACE inhibitors also increase the amount of a protein called bradykinin in your body. Bradykinin lowers your blood pressure by causing your blood vessels to relax and helping your kidneys get rid of extra salt from your blood. ACE normally breaks down bradykinin. When ACE is blocked, the amount of bradykinin in your body increases.

What Are the Side Effects of ACE Inhibitors?

A cough is one of the most commonly reported side effects of all ACE inhibitors. Research findings vary as to what percentage of people taking an ACE inhibitor experience a cough, ranging from 1 percent to more than 30 percent, according to a review in the European Journal of Internal Medicine.

Other possible side effects of ACE inhibitors include:

• Dizziness
• Headache
• Tiredness
• High potassium levels
• Changes in sense of taste
• Upset stomach and nausea
• Rash

How Do ACE Inhibitors Cause Coughing?

Researchers don’t know exactly why ACE inhibitors can cause coughing in some people. The most commonly accepted theory is, the cough is related to an increase in irritating chemicals — such as the bradykinin protein — that are usually broken down by the ACE enzyme. These irritating chemicals can cause the muscles in your airway to constrict.

An ACE inhibitor-induced cough may start within the first few weeks or months of starting the drug.

Who Develops ACE Inhibitor-Induced Coughing?

ACE inhibitor-induced coughing is less common in people diagnosed with high blood pressure and more common among some other groups. According to the European Journal of Internal Medicine review, people who are at higher risk include those who are:

• Asian
• Female
• Living with coronary artery disease, particularly heart failure
• Living with diabetes

There haven’t been many studies looking at which ACE inhibitors are more or less likely to cause a cough. People taking enalapril may be more likely to develop a cough than those taking perindopril.

What’s the Difference Between an ACE Inhibitor-Induced Cough and a Cough Due to PH?

Most coughs go away after about three weeks — this is known as an acute cough. People with a cough caused by an ACE inhibitor or PH may have a chronic cough that persists for eight weeks or longer.

People with a cough caused by an ACE inhibitor usually describe it as a dry cough that doesn’t bring up any mucus. It may feel like a scratching sensation in your throat. Most people with an ACE inhibitor-induced cough have a mild to moderate cough.

While a cough from PH may also be a dry cough, you may have additional symptoms of pulmonary hypertension, such as:

• Shortness of breath
• Coughing that brings up blood
• Chest pain
• Dizziness
• Hoarse voice
• Wheezing (a whistling sound when you breathe)

A myPHteam member described their symptoms: “I was hoarse like a person recovering from laryngitis at the end of each day. It was from the constant cough.”

Another member commented, “My voice isn’t hoarse. It’s more like I need to clear it but can’t.”

How Is an ACE Inhibitor-Induced Cough Treated?

The treatment your doctor recommends for treating your cough will depend on the severity. Do not stop taking your medication without first discussing it with your health care provider. When considering stopping your medication, bear in mind that ACE inhibitors are known to reduce your risk of dying from heart-related illness.

Your cough might go away without treatment. ACE inhibitor-induced coughing stopped without treatment for 25 percent and 50 percent of people in two studies, per the European Journal of Internal Medicine review.

Other treatment options after discussion with your health care provider include:

• Stopping your ACE inhibitor for a short time and restarting in about four weeks
• Switching to another ACE inhibitor
• Switching to another type of blood pressure medication

Can Other Blood Pressure Medications Cause Coughing?

ACE inhibitors are the blood pressure medications that are most often associated with developing a cough. However, other blood pressure medications may cause coughing.

Angiotensin II Receptor Blockers

Angiotensin II receptor blockers (ARBs) — also known as angiotensin II receptor antagonists — are often the first drug doctors recommend for people who can’t tolerate an ACE inhibitor due to coughing. ARBs work by blocking the effect of angiotensin II around your body.

Switching to an ARB may not eliminate the risk of developing a cough. Even though ARBs don’t increase bradykinin like ACE inhibitors, about 3 percent of people develop a cough while taking ARBs, according to the European Journal of Internal Medicine.

Beta-Blockers

Beta-blockers are another type of blood pressure medication that can be used to treat many different heart conditions such as heart failure, heart attack, heart rhythm problems, and chest pain. Beta-blockers can decrease your blood pressure and heart rate by blocking the effect of the hormone epinephrine (also called adrenaline) on the heart muscle and blood vessels.

People with asthma who take beta-blockers may experience increased coughing. This is because some beta-blockers can cause the airways to constrict, which can make asthma symptoms (like coughing) worse in some people.

Calcium Channel Blockers

Calcium channel blockers (CCBs) can be used to treat PH, high blood pressure, and heart rhythm problems. CCBs work by blocking the effect of calcium on your heart and blood vessels. Calcium causes your muscles to squeeze more strongly. By blocking the effect of calcium, your heart muscle and blood vessels can open and lower your blood pressure.

CCBs can cause gastroesophageal reflux disease (GERD), where acid from your stomach flows up your esophagus and into your mouth. The acid can cause a dry cough. It’s possible to have a cough from acid reflux even if you don’t feel a burning sensation. You may notice that a cough caused by a CCB may be worse after a meal.

Can Other PH Medications Cause Coughing?

Other medications used to treat PH may also cause coughing. If the oxygen levels in your blood are too low due to PH, you may use oxygen therapy. Oxygen therapy can cause coughing if your oxygen levels are too high (oxygen toxicity). Other symptoms of oxygen toxicity include chest pain, difficulty breathing, and a feeling of heaviness in your chest.

Bosentan (Tracleer) is an endothelin receptor antagonist used to treat pulmonary arterial hypertension (PAH). A rare but serious side effect of bosentan is coughing up blood.

While these medications are effective in managing hypertension, they can lead to an annoying and lingering cough in some people. If you’re experiencing this symptom, it’s important to discuss it with your health care provider, as they may need to adjust your medication or explore alternative options to ensure your blood pressure remains controlled without the troublesome cough. If you develop a new or worsening coughing while being treated for PH, contact your health care provider right away.

Talk With Others Who Understand

On myPHteam, the social network for people with pulmonary hypertension and their loved ones, more than 51,000 members come together to ask questions, give advice, and share their stories with others who understand life with PH.

Have you experienced coughing as a side effect of your blood pressure medication? How has it affected your quality of life? Share your experience in the comments below, or start a conversation by posting on your Activities page.