Which antihypertensive class is commonly associated with a dry cough due to bradykinin accumulation?

• A. Beta blockers
• B. ARBs
• C. ACE inhibitors
• D. Calcium channel blockers

Answer: (C)

A dry cough due to bradykinin accumulation is a classic adverse effect of ACE inhibitors. ACE inhibitors block the enzyme that converts angiotensin I to angiotensin II and, importantly, they also prevent the breakdown of bradykinin. With bradykinin not being degraded, it builds up in the respiratory tract and stimulates sensory nerves, leading to a persistent, nonproductive cough. This effect is characteristic of ACE inhibitors and is much less common with other antihypertensives because they don’t increase bradykinin levels. If this cough develops, switching to an ARB (which lowers blood pressure like an ACE inhibitor but doesn’t raise bradykinin) is a common solution.