Incidence of cough with angiotensin converting enzyme inhibitors in Sri Lankan population

Abstract

Angiotensin Converting Enzyme Inhibitors (ACEI) are widely used in clinical practice. Their use is often limited by cough. The incidence of cough among patients taking ACEls varies widely. The reported figures range from 2 - 33% (1). This wide variation depends partly on the method adopted to detect cough. (2) it is believed that the incidence of cough is high among Asians. This study was conducted to find the incidence of cough in the current users of ACEI in Sri Lanka. Materials and methods: We studied two groups of patients; one on regular ACEI treatment and the other age, sex and disease pattern matched controls that were not on ACEI, for a period of 9 months from January 1988. The ACEI group has 236 patients (27% females) with mean age of 55 years and the control group had 228 patients (27% females) with a mean age of 55 years. Both groups had similar disease patterns. These patients were from cardiac, diabetic, renal and general medical clinics of the National Hospital of Sri Lanka and 2 private sector hospitals in Colombo. The ACEI group patients were on ACEI for at least 4 weeks and all patients with lung signs were excluded from both groups. Patients were interviewed with the aid of a questionnaire and examined by the investigators. Results: In the ACEI group 80 (34%) had cough and 14 (6.1%) of the control group had cough. The difference between the incidences of cough amongst the groups was highly significant (p<0.001). In the ACEI group 59% of patients with cough had mild cough; the rest needed treatment for their cough. However, all were able to tolerate the ACEI inspite of cough. In the ACEI group 25 females (40% of females) and 55 males (32% of males) had cough (p-NS). 37% (25 of 93) of patients above the age of 60 and 31% patients (45 of 143) below the age of 60 had cough inthe ACEI group (p-NS). Conclusion: The incidence of cough in patients on ACEI treatment for various indications was found to be 36% in Sri Lankan patients. The incidence of cough was not significantly different among the sexes and amongst patients above and below the age of 60 years.