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ACEi Cough — RACP Adult Medicine MCQ

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EasyRespiratoryACEi CoughRACP Adult Medicine

A 45-year-old non-smoking woman presents with a 3-month history of dry cough. She has no dyspnoea, wheeze, or haemoptysis. CXR is normal. She was started on perindopril for hypertension 4 months ago. What is the most likely cause?

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Correct answer: C — ACE inhibitor-induced cough

Dry cough starting within weeks to months of ACEi initiation is ACEi-induced cough. It affects 5-35% of patients (more common in women and East Asian populations). Caused by bradykinin and substance P accumulation. Resolves within 1-4 weeks of drug cessation. Switch to an ARB (no cross-reactivity for cough). Sacubitril/valsartan may also cause cough (neprilysin inhibitor).

Reference: AMH – 2025 – ACEi; eTG Cardiovascular 2024