ACEi Cough Replacement — ESENeph MCQ

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EasyHypertensionACEi Cough ReplacementESENeph

A 55-year-old woman with CKD G3b (eGFR 35 mL/min/1.73m2) on Enalapril develops a dry persistent cough. The cough resolves when Enalapril is stopped. What is the recommended replacement?

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Correct answer: C — An ARB (e.g. Losartan)

ACEi-induced cough occurs in approximately 5-15% of patients due to bradykinin accumulation. The cough typically resolves within 1-4 weeks of stopping the ACEi. ARBs do not cause bradykinin accumulation and are the recommended replacement, maintaining the RAS blockade benefit for renal protection. KDIGO 2024 recommends ACEi or ARB as equivalent first-line agents for CKD with albuminuria. The cough is a class effect of all ACEi, so switching between ACEi is not helpful.

Reference: KDIGO 2024 – CKD Guideline; NICE CG127 2019 – Hypertension