Why do angiotensin receptor blockers (ARBs) typically not cause a dry cough?

Angiotensin receptor blockers (ARBs) typically do not cause a dry cough primarily because they cause less bradykinin formation. Unlike angiotensin-converting enzyme (ACE) inhibitors, which often lead to a cough due to the accumulation of bradykinin, ARBs work directly on the angiotensin receptors and do not inhibit the breakdown of bradykinin. As a result, the levels of bradykinin remain lower, reducing the likelihood of cough as a side effect.

This mechanism illustrates the significance of bradykinin in the cough reflex; its accumulation is a common adverse effect associated with ACE inhibitors but not with ARBs. Understanding this distinction is crucial for clinicians when selecting antihypertensive therapy for patients who may be sensitive to cough-induced side effects.