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Unknown side effects: What is the reason behind ACE inhibitors causing cough?
ACE inhibitors (Angiotensin-Converting Enzyme Inhibitors) are a class of widely used drugs, mainly used to treat hypertension and heart failure. This class of drugs effectively reduces blood pressure by relaxing blood vessels and decreasing blood volume, thereby lowering the heart's demand for oxygen. The main mechanism of action of ACE inhibitors is to inhibit the activity of angiotensin converting enzyme (ACE), a key enzyme in the renin-angiotensin system that converts angiotensin I to angiotensin II. , while also breaking down bradykinin. Therefore, ACE inhibitors reduce the production of angiotensin II, which can increase the level of bradypeptide and further promote vasodilation, an effect that is complementary to lowering blood pressure.
With elevated levels of bradypeptide, ACE inhibitors may be the root cause of the disruptive cough experienced by many patients.
Commonly prescribed ACE inhibitors include benazepril, zofenopril, perindopril, trandolapril, captopril, enalapril, enalapril, lisinopril, and ramipril. These drugs were originally licensed for the treatment of high blood pressure, but have since been found to be effective in other cardiovascular and kidney diseases, such as heart attack, heart failure, and diabetic nephropathy.
While ACE inhibitors are effective, they also come with some side effects that are not often discussed. One of the most common side effects is a persistent dry cough. The main reason for this dry cough is that ACE inhibitors reduce the production of angiotensin II, which in turn reduces the activity of adrenaline and causes an increase in the level of bradypeptide in the body. Bradypeptide is a peptide that promotes vasodilation, and for some patients, this increase may lead to the development of a dry cough.
Many patients need to switch to angiotensin II receptor antagonists when taking ACE inhibitors to reduce the occurrence of cough.
In addition to a dry cough, ACE inhibitors may also cause swelling of the throat (angioedema), a rare but potentially dangerous side effect that can make it difficult to breathe. This may be because a genetic predisposition makes some patients more likely to have an allergic reaction when using these drugs. In addition, ACE inhibitors may cause other side effects such as worsening renal function and hyperkalemia, so careful monitoring should be performed when using this type of drug.
The mechanisms of these side effects are difficult to fully understand, but the medical community has a relatively full understanding of why ACE inhibitors cause coughing. Studies have shown that patients should have their renal function closely monitored within a few days of starting ACE inhibitors, especially those with impaired renal function. In addition, the use of ACE inhibitors is also contraindicated during pregnancy or breastfeeding due to the potential harm of these drugs to the fetus.
For some people who experience an annoying cough with ACE inhibitor use, doctors may consider switching medications or adding other medications to aid treatment. Among them, angiotensin II receptor antagonists are a common alternative, which can effectively lower blood pressure without causing side effects such as coughing.
Although the use of ACE inhibitors is effective, patients must also understand the possible side effects and maintain close communication with their doctors during treatment.
In future studies, we hope to further clarify the specific mechanism by which ACE inhibitors induce cough, in order to provide safer and more effective treatment options in clinical practice. In patients using ACE inhibitors, how to balance the relationship between antihypertensive effect and side effects will be an important issue, which also echoes the core issue of medical treatment: Is there an ideal balance between efficacy and side effects? What about the balance point?
