A patient reports a dry persistent cough while taking an antihypertensive. Which class is most likely responsible?

A patient reports a dry persistent cough while taking an antihypertensive. Which class is most likely responsible?

• A. ACE inhibitors
• B. ARBs
• C. Calcium channel blockers
• D. Beta blockers

Answer: (A)

A dry, persistent cough that appears after starting an antihypertensive most likely comes from ACE inhibitors. These drugs block the enzyme that converts angiotensin I to angiotensin II and, importantly, also interfere with the breakdown of bradykinin. The buildup of bradykinin in the airways can trigger a nonproductive cough that tends to be persistent and may appear weeks after therapy begins. If the cough becomes problematic, clinicians often switch the patient to an ARB, which lowers blood pressure without increasing bradykinin and typically doesn’t cause this cough. Other antihypertensives don’t commonly produce a dry cough as a notable adverse effect: calcium channel blockers mainly cause edema and other effects, and beta blockers can cause fatigue or bronchospasm in some, but not a classic dry cough.