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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 make your cough worse.
Angiotensin-converting enzyme (ACE) inhibitors are a group of blood pressure medications often associated with causing a cough. Here’s some background information on ACE inhibitors and other blood pressure medications that might cause coughing.
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:
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.
Angiotensin-converting enzyme inhibitors work by blocking the enzyme responsible for turning a hormone called angiotensin I into angiotensin II. 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. Bradykinin lowers your blood pressure by causing your blood vessels to relax. This helps 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.
A cough is one of the most commonly reported side effects of all ACE inhibitors. Research findings vary as to how common the symptom is among people who take an ACE inhibitor, ranging from 1 percent to more than 30 percent.
Other possible side effects of ACE inhibitors include:
Not everyone taking an ACE inhibitor develops a cough. Researchers don’t know exactly why ACE inhibitors can cause coughing. The most commonly accepted theory is that 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.
ACE inhibitor-induced coughing is less common in people diagnosed with high blood pressure and more common among some other groups of people. According to the European Journal of Internal Medicine, people who are at higher risk include those who are:
Recent research suggests that some genetic factors may increase the risk of developing a cough from ACE inhibitors. One meta-analysis found that people with a specific genetic variation, ACE gene insertion, were more likely to develop a cough after taking ACE inhibitors, especially those who were Asian or older. Another study in the Journal of Human Hypertension that looked at Japanese people with high blood pressure found that having certain variants of the BK B2 receptors, the T or TT version, increased a person’s chance of developing a cough from ACE inhibitors, especially in women.
There haven’t been many studies looking at which ACE inhibitors are more or less likely to cause a cough. One study showed people taking enalapril may be more likely to develop a cough than those taking perindopril.
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. Common causes of chronic cough include chronic obstructive pulmonary disease (COPD), asthma, and infection.
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 pulmonary hypertension cough can be dry, you may have additional symptoms of pulmonary hypertension, such as:
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.”
The treatment for your cough depends on how severe it is. The decision to stop your current medication and start another should be shared with your healthcare provider. Consider how severe your cough is. ACE inhibitors are known to reduce your risk of dying from heart-related illness.
Your cough might go away without treatment. In two studies, ACE inhibitor-induced coughing stopped without treatment in 25 percent to 50 percent of people. Other treatment options your healthcare provider may suggest include:
ACE inhibitors are the blood pressure medications most often associated with developing a cough. However, other blood pressure medications may cause coughing.
Angiotensin II receptor blockers (ARBs) are often the first drug recommended if you 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.
Beta-blockers are another type of blood pressure medication. They can be used to treat many 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 can be used to treat PH, high blood pressure, and heart rhythm problems. Calcium channel blockers 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.
Calcium channel blockers 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 calcium channel blockers may be worse after a meal.
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. In rare cases, 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). Some people taking bosentan report coughing up blood, but it’s not clear whether this is a side effect of medication or a complication of PAH.
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, discuss it with a healthcare professional. 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 healthcare provider right away.
Several kinds of medication are used to improve blood flow and treat PAH. Often, PAH treatment plans involve more than one type of drug (combination therapy). Certain medications are more likely to cause coughing than others, such as some inhaled vasodilators.
If you develop a cough during PAH treatment, it’s important to tell your doctor. Your healthcare provider can help you determine if your cough is due to your condition or its treatment. If your medication is the cause, your doctor may suggest adjusting your treatment plan to better manage your cough.
On myPHteam, the social network for people with pulmonary hypertension and their loved ones, more than 56,000 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.
I've Been Experiencing Tightness And Heaviness In My Chest Quite Often! Could It Be Oxygen Toxicity Or Symptoms Of Pulmonary Hypertension?
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