Cough Management in Hypertensive Patients

Recommended Cough Medicines

The American Thoracic Society recommends dextromethorphan or menthol-based cough preparations for cough relief in patients with hypertension, while avoiding preparations containing sympathomimetic decongestants which can elevate blood pressure 1, 2
Dextromethorphan-based preparations are effective for cough suppression, with an effective dose of 60 mg, though caution is advised with high doses due to potential combined ingredients 1, 2
Menthol preparations suppress the cough reflex when inhaled, providing acute but short-lived cough suppression, and are available as menthol crystals or proprietary capsules 1, 2

Codeine or pholcodine are not recommended due to their adverse side effect profiles and lack of greater efficacy than dextromethorphan 1, 2

The American College of Chest Physicians notes that ACE inhibitors can cause a dry, persistent cough in 5-35% of patients, which typically resolves within 1-4 weeks after discontinuation of the medication 3, 4
For patients who must remain on antihypertensive therapy, switching to an angiotensin receptor blocker (ARB) is recommended as ARBs rarely cause cough 4

The American College of Chest Physicians recommends switching to an angiotensin receptor blocker (ARB) when ACE inhibitor-induced cough occurs, with losartan 25 mg once daily being the most studied ARB for this indication 5

If the patient is taking an ACE inhibitor, this may be the cause of a dry, persistent cough, and the only uniformly effective treatment is discontinuation of the medication, with cough resolution expected within 1-4 weeks 5

If cough persists despite appropriate treatment, investigate underlying causes rather than escalating symptomatic therapy 5