If you started a blood pressure or heart medicine whose name ends in “-pril,” such as lisinopril, enalapril or ramipril, and then developed a dry, tickly cough that will not go away, the medicine may be the cause. These drugs, called ACE inhibitors, slow the breakdown of bradykinin, a small peptide that can irritate the airways. The cough is not dangerous by itself, but it is worth telling your prescriber about. Keep taking the pill until you have talked, and treat any swelling of the lips, tongue or throat as an emergency.
How a blood pressure pill can set off a cough
ACE stands for angiotensin-converting enzyme. Blocking it lowers blood pressure, but the same enzyme also clears away bradykinin. The UniProt record for kininogen-1 shows bradykinin is just nine amino acids long, cut from a larger blood protein, and describes it as a strong blood-vessel widener and a mediator of inflammation that can stimulate nerve endings.
The American College of Chest Physicians guideline on ACE inhibitor cough says the exact mechanism is still unresolved, but it likely involves bradykinin and substance P, another peptide, building up in the upper airway or lungs when the enzyme is blocked, along with prostaglandins that bradykinin can stimulate.
How common it is and how it usually behaves
The same guideline puts the reported rate at 5% to 35% of people taking these medicines. The cough can begin within hours of the first pill or months later, and MedlinePlus also notes it can appear after you have been on the medicine for some time. That delay is why many people never connect the two. The guideline advises clinicians to consider an ACE inhibitor as a possible cause of any chronic cough, whenever the drug was started.
Treating the cough itself is unreliable. According to the guideline, the only treatment that works reliably is stopping the medicine, and even then the cough typically takes 1 to 4 weeks to fade and can linger for up to 3 months. In a minority of people, the cough does not come back when the drug is restarted.
What to do if you think your pill is the cause
MedlinePlus says to tell your provider if you develop a cough, and not to lower your dose without talking with them first. Sometimes a lower dose helps; sometimes the provider switches you to a different medicine. Before the appointment, it helps to note:
- When the cough started, and when you began or changed the medicine.
- Whether it is dry and tickly or brings up mucus, and whether it wakes you at night.
- Any fever, wheezing, heartburn or recent cold, since a clinician will also look at other causes.
A common alternative is an angiotensin receptor blocker (ARB), such as losartan, which works on the same hormone system without blocking the enzyme. The chest physicians’ guideline reports cough rates on ARBs similar to those on comparison drugs. A 2014 Cochrane review of nine head-to-head trials with 11,007 people found no difference in deaths or cardiovascular events between the two classes, while slightly fewer people stopped ARBs because of side effects, mainly because ACE inhibitors cause more dry cough. The reviewers also noted that the evidence that ARBs prevent heart problems is weaker than for ACE inhibitors, which is one reason the choice belongs to you and your prescriber.
The warning sign that cannot wait
Bradykinin buildup is also linked to a rarer and more serious reaction called angioedema, sudden swelling of the face, lips, tongue or throat. A 2024 review in Frontiers in Allergy describes how slower bradykinin breakdown under ACE inhibition can cause laryngeal swelling and massive tongue swelling. The MedlinePlus lisinopril page says to call your doctor immediately for swelling of the face, throat, tongue, lips or eyes, hoarseness, or trouble breathing or swallowing, and MedlinePlus’s ACE inhibitor guide says to go to the emergency room if your tongue or lips swell. The lisinopril page also warns that the drug should not be taken during pregnancy.
By The Everyday Brief · AI-assisted editorial. Drafted with AI research assistance; claims checked against the linked sources (fetched 2026-10-05 PT). Not medical advice.
Sources
- MedlinePlus (U.S. National Library of Medicine): ACE inhibitors
- MedlinePlus: Lisinopril drug information
- Dicpinigaitis PV. Angiotensin-converting enzyme inhibitor-induced cough: ACCP evidence-based clinical practice guidelines. Chest, 2006.
- Li EC, Heran BS, Wright JM. Angiotensin converting enzyme (ACE) inhibitors versus angiotensin receptor blockers for primary hypertension. Cochrane Database of Systematic Reviews, 2014.
- Ghebrehiwet B, Joseph K, Kaplan AP. The bradykinin-forming cascade in anaphylaxis and ACE-inhibitor induced angioedema/airway obstruction. Frontiers in Allergy, 2024.
- UniProt: P01042, Kininogen-1 (source of bradykinin, human)