Which adverse effect is most characteristic of ACE inhibitors?

• A. Hyperkalemia
• B. Hypotension
• C. Angioedema
• D. Persistent Dry cough

Answer: (D)

Blockade of ACE raises bradykinin levels, and this buildup in the airways irritates sensory nerves, producing a persistent dry cough. That cough is the most characteristic adverse effect of ACE inhibitors, making it a hallmark distinction from other antihypertensives. Hyperkalemia and hypotension can occur because of reduced angiotensin II and aldosterone, and angioedema can also arise (also bradykinin-related) but is less common. The cough, however, is the classic, recognizable adverse effect associated with this drug class.