What Blood Pressure Meds Cause Coughing? A Guide to ACE Inhibitors and Alternatives

October 12, 2025 •

4 min read

Affecting between 4% and 35% of users in various studies, a persistent dry cough is a well-known side effect of certain blood pressure medications. Understanding what blood pressure meds cause coughing is the first step to managing this annoying, though often harmless, side effect.

Quick Summary

A persistent dry cough is a common side effect of ACE inhibitors, caused by the buildup of bradykinin in the airways. Alternatives like ARBs are often prescribed to patients who cannot tolerate the cough. Never stop taking medication without consulting a healthcare provider first.

Key Points

ACE Inhibitors are the primary cause: A persistent, dry cough is a common and well-documented side effect of ACE inhibitors like lisinopril, enalapril, and ramipril.
Bradykinin is the mechanism: The cough is caused by the accumulation of bradykinin and substance P in the airways, a side effect of how ACE inhibitors work.
ARBs are a common alternative: Angiotensin II Receptor Blockers (ARBs), such as losartan and valsartan, are a frequent and effective substitute for patients who develop a cough from ACE inhibitors.
The cough is nonproductive: An ACE inhibitor-induced cough is typically dry and does not produce mucus or phlegm, often feeling like a tickle in the throat.
Switching medication is the cure: The only consistently effective treatment for this type of cough is to stop taking the offending ACE inhibitor, which should only be done under a doctor's supervision.
Cough suppressants don't work: Over-the-counter cough suppressants are generally ineffective for an ACE inhibitor-induced cough because they do not address the underlying cause.
Other medications can also cause cough: While less common than with ACE inhibitors, certain beta-blockers, calcium channel blockers, statins, and renin inhibitors can also cause a drug-induced cough.

Understanding Medication-Induced Cough

For many people managing high blood pressure, medication is a critical part of a long-term health plan. However, certain drugs can produce bothersome side effects, with a persistent, dry cough being one of the most common and recognizable. While not a medically serious condition in most cases, this type of cough can significantly impact a person's quality of life. Recognizing the source of the cough is essential for effective management, which almost always requires a discussion with a healthcare provider about potential medication changes. The most frequent culprits are a specific class of drugs known as ACE inhibitors.

The Main Culprits: Angiotensin-Converting Enzyme (ACE) Inhibitors

ACE inhibitors are a class of widely prescribed medications used to treat hypertension and heart failure. They work by blocking the action of the angiotensin-converting enzyme, which helps to relax blood vessels and lower blood pressure. However, this same mechanism is responsible for the cough that occurs in a significant number of patients.

Common ACE inhibitors that may cause coughing include:

Lisinopril: (Brand names include Zestril and Prinivil)
Enalapril: (Brand names include Vasotec)
Ramipril: (Brand names include Altace)
Benazepril: (Brand names include Lotensin)
Captopril:
Quinapril: (Brand names include Accupril)

The Mechanism Behind the Cough

While the exact reason is not fully understood, the most accepted theory revolves around two inflammatory compounds: bradykinin and substance P.

Normal Function: Normally, the angiotensin-converting enzyme (ACE) breaks down bradykinin and substance P in the lungs and airways.
ACE Inhibitor Action: When a patient takes an ACE inhibitor, the breakdown of these compounds is blocked, leading to their accumulation in the respiratory system.
Irritation and Cough: This buildup is believed to irritate nerve endings, triggering the persistent, dry, and tickly cough that is characteristic of this side effect.

The cough can develop at any time, from the first dose to months after starting the medication. It is not a dose-dependent effect and often does not respond to typical cough suppressants.

Identifying a Medication-Induced Cough

Recognizing if your cough is linked to your blood pressure medication involves paying attention to its characteristics and timing. It's important to rule out other causes with your doctor, such as allergies or respiratory infections.

The nature of the cough: A cough caused by an ACE inhibitor is almost always dry, nonproductive, and persistent.
Timing: It often develops within the first few weeks or months of starting the medication, though it can appear later.
Resolution upon discontinuation: The cough typically resolves within one to four weeks after stopping the ACE inhibitor, which can be the most definitive way to confirm the cause. In some cases, it can take up to three months to fully disappear.

Alternative Blood Pressure Medications

If an ACE inhibitor is causing a persistent cough, the most common and effective solution is to switch to a different class of medication. Angiotensin II Receptor Blockers (ARBs) are the preferred alternative because they target the same physiological pathway as ACE inhibitors but through a different mechanism that does not lead to the buildup of bradykinin.

Angiotensin II Receptor Blockers (ARBs)

ARBs block the angiotensin II receptors on blood vessels, preventing the hormone from causing vasoconstriction. Since they do not affect the ACE enzyme directly, they do not cause the same buildup of bradykinin and are far less likely to cause a cough.

Examples of common ARBs include:

Losartan (Cozaar)
Valsartan (Diovan)
Candesartan (Atacand)
Irbesartan (Avapro)
Olmesartan (Benicar)

Other Medication Classes

Beyond ARBs, several other types of medications can effectively treat high blood pressure without posing a significant risk of causing a cough. These may be considered by your doctor depending on your specific health profile.

Diuretics: Also known as 'water pills,' diuretics like hydrochlorothiazide (HCTZ) help the body eliminate excess sodium and water, reducing blood pressure. They have a very low risk of causing a cough.
Calcium Channel Blockers (CCBs): CCBs, such as amlodipine (Norvasc), relax and widen blood vessels. While less common than with ACE inhibitors, CCBs have been linked to coughing in rare cases.
Beta-Blockers: These medications, including metoprolol (Lopressor) and carvedilol (Coreg), work by blocking the effects of adrenaline, causing the heart to beat slower and with less force. Non-selective beta-blockers can cause coughing, especially in people with asthma.

Comparative Overview of Blood Pressure Medications


Medication Class	Mechanism of Action	Risk of Cough	Common Examples
ACE Inhibitors	Blocks the angiotensin-converting enzyme, leading to a buildup of bradykinin.	High (4–35% of patients)	Lisinopril, Enalapril, Ramipril
ARBs	Blocks angiotensin II receptors, avoiding the bradykinin pathway.	Very Low (similar to placebo)	Losartan, Valsartan, Candesartan
Diuretics	Removes excess fluid and sodium from the body.	Low	Hydrochlorothiazide (HCTZ), Chlorthalidone
Calcium Channel Blockers	Relaxes and widens blood vessels.	Low (rare cases reported)	Amlodipine, Nifedipine, Verapamil
Beta-Blockers	Slows heart rate and reduces heart's force.	Low (higher risk with non-selective types and in asthmatics)	Metoprolol, Carvedilol, Propranolol

Conclusion

A dry, persistent cough is most frequently caused by ACE inhibitors due to the accumulation of bradykinin in the airways. For individuals experiencing this frustrating side effect, effective alternatives are available. The most common and direct substitution is an ARB, which works similarly to lower blood pressure but without causing the same cough-inducing chemical buildup. Other options, such as diuretics or calcium channel blockers, may also be considered depending on the patient's overall health. It is crucial for patients to never stop their medication without consulting their healthcare provider first, as a treatment plan can be safely and effectively modified to manage side effects while still controlling blood pressure. The ultimate goal is finding a blood pressure medication that is both effective and tolerable for the patient.

One resource for further reading on medication side effects is Drugs.com's Q&A on Which blood pressure medications cause coughing?.

Frequently Asked Questions

The most likely cause is a class of medications called Angiotensin-Converting Enzyme (ACE) inhibitors. Common examples include lisinopril, enalapril, and ramipril.

ACE inhibitors block an enzyme that normally breaks down substances like bradykinin and substance P in the airways. This causes these inflammatory compounds to build up and irritate nerve endings, triggering a dry, persistent cough.

A cough caused by an ACE inhibitor is typically dry, nonproductive, and persistent, often starting weeks to months after starting the drug. A doctor may recommend stopping the medication to see if the cough resolves.

You should not stop your medication on your own. Instead, talk to your doctor. They may switch you to a different medication, such as an Angiotensin II Receptor Blocker (ARB), or another class of antihypertensive drugs.

Angiotensin II Receptor Blockers (ARBs) are the most common alternative. Other options include diuretics, calcium channel blockers, and certain types of beta-blockers.

ARBs are far less likely to cause a cough than ACE inhibitors because they do not cause the buildup of bradykinin. Their mechanism of action is slightly different.

After stopping the medication, the cough usually goes away within one to four weeks. In some cases, it can take up to three months to fully resolve.