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Dry cough is a well-known and significant side effect associated with the use of ACE inhibitors. These medications work by inhibiting the angiotensin-converting enzyme, which leads to increased levels of bradykinin in the body. Elevated bradykinin can cause irritation in the respiratory tract, resulting in a persistent dry cough. This side effect can be bothersome enough that some patients may need to discontinue the medication or switch to a different class of antihypertensive agents if the cough becomes intolerable.

Monitoring for this side effect is important because it can impact the patient's quality of life and adherence to the treatment regimen. Additionally, while the other options may pose concerns for various reasons, they are not directly associated with ACE inhibitors in the same manner. Rapid weight gain might suggest fluid retention, visual disturbances could indicate unrelated issues, and insomnia can arise from numerous causes, rather than being a direct side effect of ACE inhibitors. Understanding the specific side effects linked with ACE inhibitors is critical for effective patient education and management.