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ACE inhibitor cough — USMLE Step 3 MCQ

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EasyInternal Medicine (chronic management)ACE inhibitor coughUSMLE Step 3

A 58-year-old man returns 6 weeks after starting lisinopril for hypertension and albuminuric type 2 diabetes. Blood pressure is improved. He reports a persistent dry cough without fever, dyspnea, wheeze, heartburn, or postnasal drip. Chest examination and oxygen saturation are normal. Which of the following is the most likely explanation for this patient's findings?

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Correct answer: D — Accumulation of bradykinin from angiotensin-converting enzyme inhibition

ACE inhibitors can cause a dry cough through bradykinin and substance P accumulation; switching to an ARB is reasonable when symptoms are bothersome.

Reference: ACC/AHA hypertension guideline