Comparison of Adverse Events between Ramipril and Perindopril in Contemporary Cardiac Practice

Background: Angiotensin-converting enzyme inhibitors (ACEIs) are extensively used for the treatment and management of cardiovascular diseases. Although ACEIs are a well-tolerated medication in high percentage of patients, around 30% can develop adverse reactions like dry cough. Objective: The objective of the study was to capture the incidence of cough in patients with cardiovascular diseases that were prescribed with perindopril and ramipril in an Indian tertiary care hospital. Methods: In this observational study, the incidence of cough in patients with cardiovascular diseases that were prescribed with perindopril and ramipril was estimated. Results: A total of 223 patients were enrolled in this study. Around 50.67% patients received ramipril; among them, 6.02% received 1.25 mg, 78.95% received 2.5 mg, and 13.53% received 5 mg of ramipril. Around 35.9% ( n = 80) patients received perindopril. In perindopril group, 31.3% of the patients received 2 mg dose and 68.8% of patients received 4 mg dose. Among perindopril group, the incidence of cough was observed in 10% ( n = 8) of the patients, whereas in ramipril group, it was 19.55% ( P = 0.00136). Due to cough, in perindopril group, 6.3% (5/80) of the patients discontinued treatment whereas in ramipril group, 9% (12/133) of the patients discontinued treatment medication. Conclusions: Our study has demonstrated that perindopril has been associated with a relatively low incidence of cough compared to ramipril.