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ACE Inhibitor Cough — RACP Adult Medicine MCQ

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EasyClinical PharmacologyACE Inhibitor CoughRACP Adult Medicine

A 70-year-old woman with hypertension develops a persistent dry cough 3 weeks after starting perindopril. Her chest X-ray is clear. What is the mechanism of ACE inhibitor-induced cough?

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Correct answer: A — Increased bradykinin levels

ACE inhibitor-induced cough affects 5–20% of patients and is caused by accumulation of bradykinin and substance P in the lungs, which are normally degraded by ACE. This leads to increased cough reflex sensitivity. The cough typically resolves within 1–4 weeks of cessation. Switching to an ARB (which does not affect bradykinin metabolism) is appropriate. The cough is more common in women and patients of East Asian descent.

Reference: AMH – 2025 – ACE Inhibitors; eTG – 2025 – Cardiovascular