A high incidence of cough in Chinese subjects treated with angiotensin converting enzyme inhibitors

Chan, Wen‐Hsiung; Chan, T. Y. K.; Luk, Wing Hang; Leung, Vyl; Li, T. H.; Critchley, J. A. J. H.

doi:10.1007/bf00271377

Cited by 38 publications

(26 citation statements)

References 6 publications

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“…This is something that seems to be confirmed by the study of YE et al [25], which showed that the cough induced by ACE inhibitors was related to the I allele and II genotype and that ACE levels were significantly lower in patients with ACE inhibitor-induced cough. In addition, ACE inhibitor-related cough has been reported to be more prevalent in individuals of Asian ethnicity [26]. As the prevalence of the II genotype in white and African populations is low compared with the Asian population (18 versus 39%) [24], this provides a possible explanation why the current authors were not able to associate ACE inhibitor use with a reduced pneumonia risk in a general, essentially white population.…”

Section: Discussioncontrasting

confidence: 47%

Angiotensin-converting enzyme inhibitor use and pneumonia risk in a general population

Garde¹

2006

European Respiratory Journal

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The aim of the present study was to assess whether the use of angiotensinconverting enzyme (ACE) inhibitors is associated with a decreased risk of hospitalisation for community-acquired pneumonia (CAP) in a general, essentially white population.Data were obtained from the Dutch PHARMO Record Linkage System. Cases were defined as patients with a first hospital admission for CAP. For each case, up to four population controls were matched by age and sex.The study population comprised 1,108 patients with a first hospital admission for CAP and 3,817 matched controls. After adjusting for several confounders, ACE inhibitor use was not associated with a decreased incidence of pneumonia (adjusted odds ratio (OR) 1.12; 95% confidence interval (CI) 0.88-1.43). Additionally, no significant association was observed in patients with diabetes, respiratory diseases, heart failure, or patients with both of the last two conditions. Furthermore, adjustment of treatment effects on pneumonia risk using stratification on balancing score also showed no significant association between ACE inhibitor use and pneumonia risk within the different strata (overall adjusted OR 1.09; 95% CI 0.87-1.36).In contrast with previous findings in Asian populations, the current authors were not able to confirm the beneficial effect of angiotensin-converting enzyme inhibitors on pneumonia risk in a general, essentially white population.

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Section: Discussioncontrasting

confidence: 47%

Angiotensin-converting enzyme inhibitor use and pneumonia risk in a general population

Garde¹

2006

European Respiratory Journal

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“…The recently published Hong Kong diastolic HF study (25) investigated 150 Chinese patients with HF and preserved systolic function, and reported no significant additional benefit by adding irbesartan or ramipril to diuretic treatment. It has been stated that Chinese subjects experience a high incidence of cough when treated with ACE inhibitors (26,27). However, most of the studies that reported a high incidence of ACE inhibitor-induced cough in Chinese patients involved a very small number of patients and did not compare Chinese patients with Caucasian patients simultaneously.…”

Section: The Chinese Populationmentioning

confidence: 99%

The 2010 Canadian Cardiovascular Society guidelines for the diagnosis and management of heart failure update: Heart failure in ethnic minority populations, heart failure and pregnancy, disease management, and quality improvement/assurance programs

Howlett¹,

McKelvie²,

Costigan³

et al. 2010

Canadian Journal of Cardiology

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“…Furthermore, it was also reported that the incidence of dry cough due to ACEi's higher in Chinese patients. 22,23 The observed changes in PP and MAP indicate reductions in all treatment groups, but no significant treatment difference between aliskiren and ramipril, except in the case of aliskiren 300 mg for reduction in MAP where the difference compared with ramipril was superior.…”

Section: Discussionmentioning

confidence: 93%

“…The use of ACEis is known to produce persistent dry cough in at least 5-35% of treated patients overall, 10 but is even more prevalent in Chinese patients (44%) due to their genetic susceptibility. 22,23 Bradykinin-induced sensitization of airway sensory nerves is a potential mechanism of ACEi-induced cough. 24 Results from this study show that the incidence of cough was fourfold lower with the maximum dose of aliskiren compared with ramipril, which can be attributed to the fact that treatment with aliskiren does not inhibit bradykinin degradation.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of aliskiren, a direct renin inhibitor, compared with ramipril in Asian patients with mild to moderate hypertension

et al. 2011

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on behalf of the trial investigators 9This 8-week, randomized, double-blind, parallel-group study compared the efficacy and safety of aliskiren with ramipril in Asian patients with mild to moderate hypertension. Following a 2-to 3-week placebo run-in period, patients with mean sitting diastolic blood pressure (msDBP) X95 and o110 mm Hg were randomized to receive once daily dose of either aliskiren 75, 150, 300 mg or ramipril 5 mg for 8 weeks. Efficacy variables were the changes in msDBP and mean sitting systolic BP (msSBP) and BP control rates (o140/90 mm Hg). Safety was assessed by recording adverse events (AEs) and serious AEs (SAEs). Of 1316 randomized patients, 1160 (88.1%) completed the study. At the study endpoint, patients on aliskiren had greater mean BP reductions (14.39/11.63 mm Hg for 300 mg; 12.16/10.04 mm Hg for 150 mg; 12.24/10.66 mm Hg for 75 mg) than those on 5 mg ramipril (11.46/9.19 mm Hg). All aliskiren doses were statistically non-inferior (Po0.0001) to ramipril in reducing msDBP. The reduction in BP for aliskiren 300 mg was statistically superior vs. ramipril (Po0.002). Blood pressure control rates were higher for aliskiren (300 mg, 52.29%; 150 mg, 48.11%; 75 mg, 45.68%) than for ramipril (5 mg, 43.7%); the difference for aliskiren 300 mg vs. ramipril 5 mg was statistically significant (Po0.05). Aliskiren was well tolerated with a fourfold lower incidence of cough (0.6-1.2%) compared with ramipril (5.2%). SAEs were rare in this study (0.5%). Aliskiren produced greater BP reductions with a lower incidence of cough than ramipril in Asian patients with mild to moderate hypertension. Hypertension Research (2012) 35, 28-33; doi:10.1038/hr.2011.150; published online 8 September 2011Keywords: aliskiren; Asian; cough; ramipril INTRODUCTION Despite advances in the diagnosis and treatment of hypertension, only about 5-33% of patients achieve blood pressure (BP) control (o140/ 90 mm Hg) globally. Blood pressure control rates for the Asian population range from 9.5 to 36.6%, and in China, the rates have been estimated to be as low as 9.5%. This is of particular concern because of the increasing prevalence of hypertension (15-35%) in the Asian populations. [1][2][3][4][5][6][7] Of the many available antihypertensive drugs, angiotensin-converting enzyme inhibitors (ACEis) and angiotensin II receptor blockers that act on the renin angiotensin-aldosterone system form the mainstay of therapy today. 2,8 However, incomplete blockade of renin angiotensin-aldosterone system by these agents results in an increase in plasma renin activity and potentially limits the therapeutic benefits of these drugs. 9 Moreover, ACE inhibition also results in suppression of kininase II, which may be followed by accumulation of the protussive mediators bradykinin and substance P in the upper respiratory tract or lungs. This results in undesirable adverse effects,

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A high incidence of cough in Chinese subjects treated with angiotensin converting enzyme inhibitors

Cited by 38 publications

References 6 publications

Angiotensin-converting enzyme inhibitor use and pneumonia risk in a general population

Angiotensin-converting enzyme inhibitor use and pneumonia risk in a general population

The 2010 Canadian Cardiovascular Society guidelines for the diagnosis and management of heart failure update: Heart failure in ethnic minority populations, heart failure and pregnancy, disease management, and quality improvement/assurance programs

Efficacy and safety of aliskiren, a direct renin inhibitor, compared with ramipril in Asian patients with mild to moderate hypertension

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