Pharmacology · patient case question
Which adverse effect is most characteristic of lisinopril and results from bradykinin accumulation?
Patient case: Polypharmacy — Cardiovascular & GI
demo: 68-year-old male
chief: “I need a crown on my lower left molar.”
history: Hypertension, gastroesophageal reflux disease, atrial fibrillation, hyperlipidemia, gout. Non-smoker.
meds: Lisinopril, omeprazole, verapamil, apixaban, rosuvastatin, allopurinol
findings: BP 132/84 mmHg. Generalized attrition. Tooth #19 with fractured MOD amalgam, no pulpal symptoms. No active periodontal disease.
Show answer and explanation
Correct answer: C. Dry, persistent cough
- A. Reflex tachycardia is more typical of direct vasodilators such as hydralazine and of dihydropyridine calcium channel blockers.
- B. Gingival hyperplasia is associated with calcium channel blockers, phenytoin, and cyclosporine — not ACE inhibitors.
- C. Correct. ACE also degrades bradykinin. When ACE is inhibited, bradykinin accumulates and produces the classic dry cough; angioedema is the same mechanism in its severe form.
- D. ACE inhibitors cause hyper‑, not hypokalemia, because reduced aldosterone decreases potassium excretion.
Note: Long-term NSAID use blunts the antihypertensive effect of ACE inhibitors and raises the risk of renal injury — relevant when writing post-operative analgesia for this patient.