A 55-year-old diabetic female has hypertension; persistent dry cough from an ACE inhibitor; best management step to control blood pressure?

Enhance your readiness for the Physician Assistant Clinical Knowledge Rating and Assessment Tool (PACKRAT) 4 Exam. Utilize our flashcards and multiple-choice questions, complete with hints and explanations, to ace your upcoming test!

Multiple Choice

A 55-year-old diabetic female has hypertension; persistent dry cough from an ACE inhibitor; best management step to control blood pressure?

Explanation:
When an ACE inhibitor causes a persistent dry cough, the best way to maintain blood pressure control is to switch to an angiotensin II receptor blocker. ACE inhibitors raise bradykinin levels, which leads to the cough in some patients. ARBs block the same final pathway (angiotensin II), but they don’t increase bradykinin, so the cough typically resolves while still providing the same BP-lowering and renal-protective benefits—especially important in a diabetic patient. Adding a diuretic could help further lower blood pressure but wouldn’t resolve the cough; stopping the ACE inhibitor would remove BP control; doing nothing would leave hypertension uncontrolled.

When an ACE inhibitor causes a persistent dry cough, the best way to maintain blood pressure control is to switch to an angiotensin II receptor blocker. ACE inhibitors raise bradykinin levels, which leads to the cough in some patients. ARBs block the same final pathway (angiotensin II), but they don’t increase bradykinin, so the cough typically resolves while still providing the same BP-lowering and renal-protective benefits—especially important in a diabetic patient. Adding a diuretic could help further lower blood pressure but wouldn’t resolve the cough; stopping the ACE inhibitor would remove BP control; doing nothing would leave hypertension uncontrolled.

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