A patient on an ACE inhibitor develops a persistent dry cough. Which symptom indicates a need to reconsider the ACE inhibitor therapy?

• A. Persistent dry cough
• B. Dizziness
• C. Headache
• D. Fatigue

Answer: (A)

ACE inhibitors can cause a persistent dry cough because they increase bradykinin levels in the respiratory tract. This accumulation leads to irritation and a nonproductive cough in some patients. When a patient on an ACE inhibitor reports a bothersome, ongoing cough, it signals reconsideration of the therapy because continuing the drug may worsen discomfort and adherence, and there is also a risk, though less common, of angioedema with this class.

In this scenario, the persistent dry cough is the red flag that prompts evaluating alternatives, such as switching to an angiotensin receptor blocker (ARB), which lowers blood pressure through a similar pathway but does not increase bradykinin. Other symptoms like dizziness, headache, or fatigue can occur with many drugs and are not as specific to ACE inhibitors; they may reflect hypotension or other issues and do not by themselves mandate stopping the medication.