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Ramipril induces cough more frequently than imidapril Ramipril is associated with a higher incidence of cough than imidapril, and this lower incidence observed with imidapril appears to be mediated by some mechanism independent of prostaglandin synthesis, according to researchers from Italy in their study presented at the 25th Annual Scientific Meeting of the American Society of Hypertension. After a 1-week placebo period, 84 hypertensive patients who developed cough on chronic ramipril therapy were randomised to receive either ramipril 10mg or imidapril 20mg for 8 weeks; patients who subsequently still complained of cough were allocated to also receive either indometacin 50mg twice daily or placebo for 4 weeks in a double-dummy, double-masked, cross-over design. At the end of the 8-week monotherapy phase, 98% of ramipril recipients complained of cough, compared with 55% of imidapril recipients (p < 0.01). Indometacin addition eliminated cough in 20% of ramipril recipients and 22% of imidapril recipients, while cough intensity and frequency* was reduced in 51% and 52% of patients, respectively; these between-group differences were not statistically significant, note the researchers. * rated via a self-administered 10-point visual analogue scale Fogari R, et al. DIFFERENCE IN INCIDENCE OF COUGH INDUCED BY IMIDAPRIL AND RAMIPRIL: ROLE OF PROSTAGLANDIN SYNTHESIS INHIBITION. 25th Annual Scientific Meeting of the American Society of Hypertension : abstr. PO-34, 1 May 2010. Available from: URL: http://www.ash803014598 us.org

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Reactions 15 May 2010 No. 1301