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ACE inhibitors block the angiotensin-converting enzyme, which converts angiotensin I to angiotensin IIa peptide hormone that causes vasoconstriction, or narrowing of the blood vessels. By blocking this necessary step in the renin-angiotensin system, ACE inhibitors lower blood pressure.
While researchers dont fully understand why ACE inhibitors cause some people to develop a cough, the generally accepted mechanism is as follows:
- Bradykinin is a peptide that acts as a vasodilator, meaning that it widens blood vessels. Bradykinin normally has a short half-life, and it is degraded by the angiotensin-converting enzyme.
- Bradykinins activity and concentration can increase when a person takes an ACE inhibitor. Excess bradykinin can accumulate in the upper and lower respiratory tracts and trigger a cough.
- Bradykinins also stimulate prostaglandins, compounds involved in the immune response, which may increase inflammation in the area and result in coughing.
Its impossible to predict when an ACE inhibitor-related cough will develop. It can begin hours after the first dose, or after taking the drug for months.
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