Welcome to Heart Matters – Empowering Heart Health
Symptoms

Do you have a persisting dry cough? Read on

As a Cardiologist, I frequently hear patients discussing a dry cough – one of the more common symptoms they encounter. Despite undergoing multiple tests to identify potential causes such as asthma, COVID-19, lung disease, or gastric reflux, the cough persists. It might even be more noticeable during nighttime. So, the question arises: Which medication could be responsible for this? Let’s delve deeper!

If you’ve been diagnosed with hypertension (high blood pressure) and are undergoing medication, you might have experienced a dry cough as a potential side effect. In this article, we will illuminate the relationship between a dry cough and blood pressure medications, specifically focusing on ACE inhibitors (Angiotensin-Converting Enzyme inhibitors). Grasping this connection will aid those on these medications in recognizing and effectively managing this frequently encountered side effect through consultations with their healthcare provider.

Gaining Insight into ACE Inhibitors

ACE inhibitors, a commonly prescribed medication class for managing high blood pressure, work by relaxing blood vessels, minimizing fluid retention, and consequently reducing blood pressure levels. They influence a rather intricate hormonal system in our bodies, known as the renin-angiotensin-aldosterone system, essential for maintaining normal homeostasis.

ACE inhibitors function by blocking the ACE receptors, which leads to reduced constriction of blood vessels and the elimination of excess salt and fluids. This mechanism contributes to the reduction of blood pressure.

 

ACE inhibitors consistently demonstrate cardiovascular protection by improving survival rates and decreasing the risk of significant cardiovascular events. These benefits span diverse patient groups affected by vascular conditions like hypertension, stable coronary artery disease, myocardial infarction (MI), and heart failure (HF). Additionally, ACE inhibitors prove their effectiveness in preventing strokes and delivering cardioprotective and nephroprotective effects for individuals with diabetes.

 

The cardiovascular advantages of ACE Inhibitors have prompted wide approval from prominent clinical practice guidelines including the European Society of Cardiology (ESC), the American Heart Association (AHA), the American College of Cardiology (ACC), and the Cardiac Society for Australia and New Zealand (CSANZ). Consequently, these guidelines advocate for ACE inhibitors as the preferred choice in managing coronary and atherosclerotic vascular diseases, high blood pressure, heart failure and in the treatment of patients following heart attack (myocardial infarction).

The Dry Cough Side Effect

The ACE inhibitor cough is often described as persistent and unproductive, meaning it does not produce mucus or phlegm. While the exact mechanism behind this side effect is not fully understood, it is believed to be related to the accumulation of bradykinin, which causes blood vessels to dilate. ACE inhibitors block the breakdown of bradykinin, leading to its increased levels, which can irritate the respiratory tract and trigger a cough reflex.

Taking Control of the Dry Cough

If ACE inhibitors are causing you to experience a dry cough, engaging with your healthcare provider becomes essential. They will evaluate the cough’s severity, assess your condition, and deliberate on potential adjustments or alternatives for your medication routine.

In certain instances, the body may adapt to the medication over time, resolving the cough. Nevertheless, when the cough persists and disrupts your comfort, your healthcare provider might explore transitioning you to a different category of blood pressure medication, such as angiotensin receptor blockers (ARBs). ARBs operate differently from ACE inhibitors and are less likely to induce the dry cough side effect. For milder cases, tweaking the dosage or introducing other blood pressure therapy categories to complement the ACE inhibitor – such as incorporating calcium channel blockers like amlodipine or diuretics like thiazides – could also assist in mitigating the cough.

 

Angiotensin receptor blockers may be an alternative to ACE inhibitors where cough is persisting.

 

Conclusion

If you are taking ACE Inhibitors and facing a persistent dry cough, it’s important to recognize that this could be a side effect of the medication. While the ACE inhibitor-induced cough may be bothersome, it should not overshadow the positive impact these medications have on cardiovascular health. By addressing potential side effects in partnership with your healthcare professional, you can strive for optimal heart health while minimizing inconvenience.

 

About the author

Heart Matters, edited by cardiologist Professor Peter Barlis, is a trusted resource that offers clear and accurate information on cardiovascular health. It bridges the gap between scientific research and everyday understanding, empowering you to make informed choices and take an active role in supporting your heart health.

Our Youtube Channel

Discover our Heart Matters YouTube channel, where we bring heart health to life. From explaining common conditions and symptoms to discussing the latest research, our engaging videos simplify complex topics, ensuring you have access to valuable knowledge for a healthier heart. Subscribe now and embark on a journey of education, empowerment, and inspiration.

Subscribe to our newsletter and be the first to receive valuable insights, tips, and resources on heart health.

other anti-anginals

When first-line therapies for angina, such as beta blockers, calcium channel blockers, and nitrates, prove inadequate or are not well-tolerated, second-line therapies may be considered.
Perhexiline is a unique medication that enhances the heart's ability to utilize fatty acids for energy, reducing its reliance on oxygen and lowering oxygen demand. This action helps improve blood flow and alleviates chest pain in some patients with refractory angina.
Nicorandil is another second-line option with a dual mechanism of action. It opens potassium channels in smooth muscle cells, causing vasodilation and enhancing coronary blood flow. Additionally, nicorandil also stimulates nitric oxide release, further dilating blood vessels and reducing heart workload.
Trimetazidine is an anti-ischemic agent that improves cardiac efficiency by enhancing glucose metabolism and shifting the heart's energy production to a more oxygen-efficient process. As second-line therapies, these medications offer alternative approaches for managing angina in individuals who do not respond adequately to first-line treatments or those experiencing side effects from other medications.

lipid lowering therapies

Lipid-lowering therapies are essential in managing coronary artery disease (CAD), a condition where the arteries supplying blood to the heart become narrowed. Among the most commonly prescribed treatments are statins, which reduce cholesterol production in the liver and significantly lower the risk of heart attacks and strokes.

Other medications may be used to target different aspects of lipid metabolism:

  • Ezetimibe helps reduce the absorption of cholesterol in the gut
  • Fibrates lower triglyceride levels
  • Niacin can help raise high-density lipoprotein (HDL) cholesterol

In recent years, a newer class of medications known as PCSK9 inhibitors—such as Repatha (evolocumab)—has become available. These drugs block a specific enzyme involved in cholesterol regulation and can dramatically lower LDL cholesterol, particularly in patients who do not achieve target levels with statins alone.

Together, these therapies provide a range of options to personalise treatment and improve cardiovascular outcomes.

Nitrates

Nitrates for Angina Relief

Nitrates are widely used to treat angina and provide quick relief from chest pain. These medications are commonly available as sublingual sprays or tablets, skin patches, and long-acting tablets.

Nitrates work by dilating blood vessels, allowing for increased blood flow and reduced vascular resistance. This reduces the heart’s workload and lowers its oxygen demand, offering prompt relief from angina symptoms.

Sublingual nitrates act quickly and are typically used at the onset of angina symptoms, while patches and long-acting tablets are used for ongoing prevention.

Common side effects include headaches, dizziness, and flushing. These often improve with continued use but should be discussed with a healthcare provider if persistent or bothersome.

calcium channel blockers

Calcium channel blockers, including amlodipine, felodipine, Cardizem (diltiazem), and verapamil, are commonly prescribed for the treatment of angina.

These medications work by inhibiting the influx of calcium into the muscle cells of the heart and blood vessels, causing them to relax. This relaxation leads to the widening of blood vessels, which improves blood flow and reduces blood pressure.

For individuals with angina, calcium channel blockers reduce the heart’s workload and oxygen demand, helping to relieve chest pain and prevent angina episodes.

While effective, they may cause side effects such as headaches, dizziness, facial flushing, and ankle swelling. These effects should be monitored and discussed with your healthcare provider if they persist.

Beta blockers

Beta blockers, such as metoprolol, propranolol, atenolol, carvedilol, and bisoprolol, play a crucial role in managing angina.

These medications work by blocking specific receptors in the heart, which slows the heart rate and reduces the strength of each contraction. This results in a lower oxygen demand by the heart and helps relieve chest pain associated with angina.

Beta blockers are highly effective in both relieving symptoms and preventing angina episodes. However, they may cause side effects in some individuals, including tiredness, worsened asthma symptoms, more vivid dreams, and erectile dysfunction in some males.

It is important to consult your healthcare provider to determine whether beta blockers are a suitable option for your angina and overall heart health.

Anti-platelet Medications

Anti-platelet medications play a crucial role in preventing blood clot formation and reducing the risk of serious cardiovascular events such as heart attacks and strokes. Commonly used agents include aspirin, clopidogrel, and ticagrelor.

 

Aspirin: This well-known medication inhibits platelet activation, reducing the likelihood that platelets will clump together and form clots. It is widely used for both primary and secondary prevention of heart attacks and strokes.

 

Clopidogrel: A potent anti-platelet agent, clopidogrel works by blocking specific receptors on platelets to prevent aggregation. It is commonly prescribed for patients with acute coronary syndrome, those undergoing stent placement, and some individuals with peripheral arterial disease.

 

Ticagrelor: Ticagrelor also inhibits platelet activation and is typically used in the treatment of acute coronary syndrome. It is often prescribed alongside aspirin to provide dual anti-platelet therapy and further reduce the risk of heart-related events.