Eprosartan versus enalapril in hypertensive patients with angiotensin-converting enzyme inhibitor-induced cough

This multicenter, double-masked, double-dummy, randomized study was undertaken to compare the incidence of persistent, nonproductive cough during eprosartan or enalapril treatment or when receiving placebo in patients with mild-to-moderate hypertension and a history of angiotensin-converting enzyme inhibitor-induced cough. Patients were administered eprosartan 300 mg twice daily, enalapril 20 mg once daily, or placebo for 6 weeks. The primary efficacy variable was the incidence of persistent, nonproductive cough; secondary outcome measures included cough severity, changes in vital signs, response to antihypertensive therapy, and incidence of adverse events. Eprosartan significantly reduced the risk of nonproductive cough by 88% (P = 0.008) and maximum cough by 57% (P = 0.0085) compared with enalapril. Both the incidence and severity of cough end points in the eprosartan and placebo groups were comparable. The blood pressure response rate to treatment was 53% in the eprosartan group compared with 42% and 25% in the enalapril and placebo groups, respectively. Adverse events occurred more frequently in patients treated with enalapril than in those who received eprosartan or placebo. The incidence of cough of any nature or severity in the eprosartan group was comparable to that seen in the placebo group. Overall, persistent, nonproductive cough was clinically and statistically less in eprosartan- than in enalapril-treated patients. Eprosartan was at least as effective as enalapril at lowering blood pressure, and treatment with eprosartan was safe and well tolerated.