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.

Do you have a persisting dry cough? Read on Heart Matters

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.


Do you have a persisting dry cough? Read on Heart Matters

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



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.


Search articles


Subscribe for exclusive heart health resources, valuable tips, and the latest research updates.

Editor's Picks

Empowering heart health

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 play a critical role in managing coronary artery disease (CAD), a condition characterized by the narrowing of blood vessels that supply the heart. Among the most commonly discussed and debated classes of medications are statins, which effectively reduce cholesterol levels and are widely prescribed to lower the risk of cardiovascular events. Alongside statins, other medications like ezetimibe, fibrates, and niacin are also utilized to target specific aspects of lipid metabolism, such as cholesterol absorption, triglyceride levels, and raising high-density lipoprotein (HDL) cholesterol. Additionally, the introduction of medications that inhibit PCSK9, an enzyme involved in cholesterol metabolism, has provided a promising new approach to further lower LDL cholesterol levels. These PCSK9 inhibitors, such as Repatha (evolocumab), have shown significant efficacy in reducing LDL cholesterol levels in patients with CAD, especially for those who may not respond well to traditional therapies.


Nitrates are widely used to treat angina and provide quick relief for chest pain. Commonly available in the form of sublingual sprays or tablets, patches, and long-acting tablets, nitrates work by dilating blood vessels, allowing for increased blood flow and reduced resistance. This dilation eases the heart's workload, leading to a decreased demand for oxygen and prompt alleviation of angina symptoms. Sublingual nitrates act rapidly and are often used to provide immediate relief during angina attacks, while patches and long-acting tablets are employed for preventive purposes. However, nitrates may cause side effects such as headaches, dizziness, and flushing, which usually subside over time.

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, leading to their relaxation. As a result, blood vessels widen, promoting improved blood flow and reduced blood pressure. In the context of angina, this relaxation decreases the heart's workload, lowering the demand for oxygen and alleviating chest pain. Calcium channel blockers offer a valuable treatment option for individuals with angina, but it is essential to be aware of potential side effects, which may include headaches, dizziness, flushing, and ankle swelling.

Beta blockers

Beta blockers, such as metoprolol, propranolol, atenolol, carvedilol, and bisoprolol, play a crucial role in treating angina. By blocking certain receptors in the heart, they effectively reduce heart rate and the force of contraction, thereby easing the heart's workload. This mechanism of action leads to a decreased demand for oxygen, making beta blockers highly effective in relieving chest pain associated with angina. As with any medication, it's important to consider potential side effects, including tiredness, worsened asthma, erectile dysfunction in some males, and more vivid dreams during sleep. Consult your healthcare provider to determine the suitability of beta blockers for managing your angina and overall heart health.

Anti-platelet Medications

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

Aspirin: This well-known medication inhibits platelet activation, making it less likely for platelets to stick together and form clots. Aspirin is commonly used for primary and secondary prevention of heart attacks and strokes.

Clopidogrel: As a potent anti-platelet agent, clopidogrel works by blocking specific receptors on platelets, preventing them from aggregating. It is often prescribed to patients with acute coronary syndrome, those undergoing stent procedures, and for some cases of peripheral arterial disease.

Ticagrelor: Ticagrelor is another effective anti-platelet drug that works by inhibiting platelet activation. It is used in acute coronary syndrome, often given alongside aspirin to reduce the risk of heart-related events.