What Blood Pressure Medicine Makes You Cough? Unveiling the Culprit

October 5, 2025 •

6 min read

As many as 5–35% of people taking angiotensin-converting enzyme (ACE) inhibitors, a common class of blood pressure medications, report a persistent, dry cough. This well-documented side effect can be bothersome and may lead to treatment discontinuation if not properly addressed with a healthcare provider. This article explains what blood pressure medicine makes you cough, why it occurs, and the alternatives available.

Quick Summary

ACE inhibitors are a common class of blood pressure medicine that causes a persistent dry cough in some individuals. The side effect is linked to an accumulation of bradykinin in the airways. Alternatives like ARBs are often prescribed to manage blood pressure effectively and avoid the cough.

Key Points

Primary Cause: Angiotensin-Converting Enzyme (ACE) inhibitors are the most common type of blood pressure medicine to cause a persistent dry cough.
Mechanism: ACE inhibitors cause a cough by preventing the breakdown of bradykinin, which irritates nerves in the respiratory tract.
Characteristics: The cough is typically dry, non-productive, persistent, and has a tickling or scratching sensation in the throat.
Treatment: The only effective treatment is to discontinue the ACE inhibitor under a doctor's supervision.
Alternative Medications: Angiotensin II Receptor Blockers (ARBs), such as losartan, are effective alternatives that cause a cough much less frequently.
Management: If you experience this side effect, do not stop your medication abruptly; consult your healthcare provider to discuss alternative treatment options.
Individual Variability: Not everyone who takes an ACE inhibitor will develop a cough, and risk factors include gender (female), ethnicity (Asian), and smoking status (non-smoker).

The Primary Culprit: Angiotensin-Converting Enzyme (ACE) Inhibitors

Angiotensin-converting enzyme (ACE) inhibitors are a class of medications widely prescribed to treat high blood pressure, heart failure, and chronic kidney disease. These medications are generally effective and considered a first-line therapy for many patients. However, a significant percentage of patients experience an annoying and persistent dry cough while taking them.

Common examples of ACE inhibitors include:

Lisinopril (Zestril)
Enalapril (Vasotec)
Ramipril (Altace)
Captopril
Benazepril (Lotensin)
Quinapril (Accupril)
Perindopril

If your blood pressure medication name ends in "-pril," it is likely an ACE inhibitor, and therefore a possible cause of a medication-induced cough.

Why Does an ACE Inhibitor Cause a Cough?

While the exact mechanism is not fully understood, the prevailing theory centers on the medication's effect on a substance called bradykinin.

ACE inhibitors work by blocking the angiotensin-converting enzyme (ACE), which is responsible for converting angiotensin I into angiotensin II, a powerful vasoconstrictor. By preventing this conversion, ACE inhibitors help relax blood vessels and lower blood pressure. However, the ACE enzyme also plays a role in breaking down bradykinin, a substance involved in inflammation and vasodilation.

When ACE is blocked by the medication, bradykinin and other related substances, such as substance P, accumulate in the respiratory tract. This accumulation is believed to irritate nerve endings in the airways, triggering the persistent dry cough. This is an idiosyncratic reaction, meaning it does not depend on the dose and only affects certain individuals. Factors that may increase the risk include being female, being a non-smoker, and of Asian descent.

Characteristics of the ACE Inhibitor-Induced Cough

If you have recently started a blood pressure medication and developed a new cough, it's essential to recognize the characteristics of an ACE inhibitor-induced cough. These features distinguish it from a cough caused by an infection or other respiratory condition:

Dry and non-productive: The cough does not produce phlegm or mucus.
Persistent and chronic: It lingers for an extended period, often weeks or months.
Tickling or scratching sensation: Patients often report an itchy or tickling feeling in the throat that prompts the coughing reflex.
Variable onset: It can begin within hours of the first dose or emerge weeks to months after starting the medication.
Resolves upon discontinuation: The cough typically disappears within one to four weeks after stopping the medication, though it can take up to three months.

Alternatives to ACE Inhibitors

If the cough is bothersome, your healthcare provider will likely recommend switching to an alternative class of medication. The most common alternative is an Angiotensin II Receptor Blocker (ARB), which works on the same hormonal pathway but at a different point. ARBs block angiotensin II from binding to its receptors, which means they do not interfere with the breakdown of bradykinin and therefore have a significantly lower risk of causing a cough.

Other potential alternatives include:

Calcium Channel Blockers (CCBs): Work by relaxing blood vessels and are not known to cause a cough as a class effect. Examples include amlodipine and diltiazem.
Diuretics ("Water Pills"): Help the kidneys remove excess fluid and sodium, lowering blood pressure. Examples include hydrochlorothiazide.
Beta-Blockers: Reduce heart rate and the force of the heart's contractions. They are an option for younger patients or those with specific heart conditions.

Comparison of ACE Inhibitors and ARBs


Feature	ACE Inhibitors (e.g., Lisinopril)	Angiotensin II Receptor Blockers (ARBs) (e.g., Losartan)
Mechanism of Action	Blocks the conversion of angiotensin I to angiotensin II by inhibiting the ACE enzyme.	Blocks angiotensin II from binding to receptors, preventing its vasoconstrictive effects.
Effect on Bradykinin	Increases bradykinin levels by inhibiting its breakdown.	No significant effect on bradykinin levels.
Incidence of Cough	Common (up to 35% of patients in some studies).	Rare (comparable to placebo, around 3% of patients).
Onset of Cough	Can occur anytime from hours to months after starting treatment.	Very low risk of cough, especially for those with a history of ACE inhibitor-induced cough.
Drug Naming Convention	Typically end in "-pril".	Typically end in "-sartan".

How to Manage a Medication-Induced Cough

If you develop a cough while on an ACE inhibitor, it is crucial to consult your doctor. Never stop taking your prescribed medication on your own, as this could have adverse effects on your blood pressure and overall cardiovascular health. Your doctor can help determine if the cough is indeed from your medication and discuss the best course of action.

Management options include:

Switching to an ARB: As ARBs do not cause the same build-up of bradykinin, they are the most common and effective solution for patients who cannot tolerate an ACE inhibitor.
Re-evaluating the treatment plan: Your doctor may consider other classes of blood pressure medication, like calcium channel blockers or diuretics, depending on your health profile.
Considering combination therapy: Some studies suggest that combining an ACE inhibitor with a calcium channel blocker can reduce the incidence of cough.

In some cases, the cough is mild enough that a patient and doctor may decide to tolerate it, especially if the ACE inhibitor is particularly effective for their condition. However, for many, the quality of life impact warrants a change in medication.

Conclusion

For those wondering what blood pressure medicine makes you cough, the answer is most commonly a medication from the ACE inhibitor class. This side effect is a result of the drug's impact on bradykinin, causing a persistent, dry, and often irritating cough. The good news is that effective alternatives, most notably ARBs, exist that provide similar therapeutic benefits without the high risk of a cough. If you experience this symptom, consult your healthcare provider to discuss treatment options. Switching medication classes is a safe and effective way to manage your blood pressure while resolving the cough and improving your overall quality of life.

This information is for educational purposes only and is not a substitute for professional medical advice. Always consult your healthcare provider for any questions regarding your medical condition or treatment.

Possible Drug Interactions to Be Aware Of

While ACE inhibitors and ARBs are effective, they can interact with other medications. For instance, combining either with certain diuretics, potassium supplements, or NSAIDs (like ibuprofen) can affect potassium levels or kidney function. Discussing all your medications, including over-the-counter products, with your doctor is essential to prevent these interactions.

The Role of Genetics in ACE Inhibitor Cough

Some evidence suggests that genetic variations may play a role in whether an individual develops an ACE inhibitor-induced cough. A meta-analysis found that people with a specific genetic variation, the ACE gene insertion, were more likely to develop a cough, especially among Asian or older individuals. This may explain why not everyone who takes an ACE inhibitor experiences this side effect.

The Lingering Nature of the Cough

One of the most frustrating aspects of an ACE inhibitor-induced cough is its persistence. It does not respond to typical over-the-counter cough suppressants because it is not caused by a virus or mucus buildup. The only effective treatment is to stop the offending medication, which is why close communication with a healthcare provider is vital.

The Importance of Accurate Diagnosis

It is crucial to remember that not all coughs in patients taking ACE inhibitors are caused by the medication. Other potential causes include asthma, postnasal drip, or gastroesophageal reflux disease (GERD). A doctor will perform a thorough evaluation to ensure the correct diagnosis. In some cases, discontinuing the ACE inhibitor for a trial period (a "dechallenge") is the definitive way to confirm the cause.

Other Medications That Can Cause Cough

While ACE inhibitors are the most common culprits, other blood pressure medications can also cause a cough, though less frequently. These include:

Certain Beta-Blockers: Nonselective beta-blockers (like propranolol) can cause airway constriction in some people, particularly those with asthma.
Calcium Channel Blockers: While rare, they can sometimes cause a cough by worsening acid reflux.
Statins: Some cholesterol-lowering drugs have also been linked to a cough in some individuals.

Frequently Asked Questions

ACE inhibitors are a class of blood pressure medications often identifiable by the suffix "-pril." Common examples include lisinopril (Zestril), enalapril (Vasotec), ramipril (Altace), and captopril.

An ACE inhibitor cough is typically a persistent, dry cough that does not produce mucus. It is often described as a tickling or scratching sensation in the throat that can be quite irritating.

The onset of the cough can vary widely. It may begin within hours of the first dose, or it could take weeks or even months to appear.

The only effective way to stop the cough is to discontinue the ACE inhibitor. This must be done under a doctor's guidance, who will likely prescribe an alternative medication, such as an ARB, that does not cause the same side effect.

The most common and effective alternative is an Angiotensin II Receptor Blocker (ARB). These medications work similarly to ACE inhibitors but do not cause the build-up of bradykinin that leads to a cough.

No, standard cough suppressants are generally ineffective for an ACE inhibitor-induced cough because they do not address the underlying cause related to bradykinin accumulation. Discontinuation of the medication is the only proven solution.

No, it takes time for the body's bradykinin levels to return to normal. The cough typically resolves within one to four weeks after stopping the medication, but in some cases, it can take up to three months.

While the risk is significantly lower than with ACE inhibitors, a small percentage of patients (around 3%) may still develop a cough while on an ARB. However, ARBs are the preferred alternative for those who experience the ACE inhibitor-induced cough.

Yes, other classes of medications can be used, including Calcium Channel Blockers (CCBs), Diuretics, and Beta-Blockers. The choice of alternative medication depends on the patient's specific health profile.