Which medication class is associated with cough, angioedema, and hyperkalemia?

• A. ACE inhibitors
• B. Spironolactone
• C. Beta-blockers
• D. Calcium channel blockers

Answer: (A)

Cough, angioedema, and hyperkalemia are classic adverse effects of ACE inhibitors. These drugs block the enzyme that converts angiotensin I to angiotensin II, which lowers aldosterone levels and reduces potassium excretion, leading to hyperkalemia. They also prevent the breakdown of bradykinin, so bradykinin accumulates. This buildup causes a dry, persistent cough and can trigger bradykinin-mediated angioedema. Other antihypertensives don’t typically produce this combination: spironolactone can raise potassium but doesn’t cause bradykinin-related cough or angioedema; beta-blockers can cause fatigue or bronchospasm but not the bradykinin-related effects; calcium channel blockers can cause edema but not this bradykinin-mediated set.