What common side effect should patients be made aware of when starting ACE inhibitors like enalapril?

When patients begin treatment with ACE inhibitors such as enalapril, one common side effect that they should be made aware of is a dry cough. This occurs because ACE inhibitors inhibit the angiotensin-converting enzyme, which plays a role in the conversion of angiotensin I to angiotensin II. This action not only helps lower blood pressure but also increases the levels of bradykinin, a peptide that can cause irritation and lead to a persistent dry cough.

Patients often find this side effect to be bothersome, and it's important for healthcare providers to communicate this possibility so that patients can monitor for it and report if it becomes troublesome. Managing expectations regarding this side effect is crucial for adherence to the medication and overall treatment success. While weight gain, increased appetite, and headache may occur with various medications, they are not commonly associated with ACE inhibitors, making the dry cough the most pertinent side effect to discuss with patients initiating therapy.