Which two racial groups have a higher incidence of cough with ACE inhibitors?

• A. Whites and Hispanics
• B. Blacks and Asians
• C. Native Americans and Pacific Islanders
• D. Arabs and Latinos

Answer: (B)

Cough from ACE inhibitors happens because these drugs raise bradykinin levels in the airways, and this buildup can trigger a dry, persistent cough in some people. The likelihood of this side effect isn’t the same across all populations; evidence shows it’s more common in Blacks and Asians. Genetic or metabolic differences in bradykinin processing or ACE activity may contribute to that increased risk. So in a patient from these groups who develops a new persistent cough after starting an ACE inhibitor, it’s sensible to consider switching to an angiotensin receptor blocker, which does not raise bradykinin. Other groups don’t show as consistent a pattern for this specific cough, though cough can occur in anyone taking an ACE inhibitor.