OBJECTIVES: Cough is a widely recognised adverse effect of Angiotensin-converting enzyme inhibitors (ACEI) and has been linked to poor medication compliance and potentially poorer quality of life (QoL). Clinically, AIIRAs (Angiotensin II receptor antagonists) have been shown to reduce the occurrence of cough relative to ACEIs. This study was designed to determine the impact of cough on patients' QoL by using generic and cough-specific QoL measures and contingent valuation (CV) methodology. METHODS: Ninety-one patients currently on ACEIs and 48 patients switched from ACEIs to AIIRAs were recruited from across Australia. Both groups were asked to complete the World Health Organisation Quality of Life questionnaire (brief version) (WHOQoL-Bref) and to answer general questions on QoL, health and demographics. Those on ACEIs also completed the Cough-specific Quality of Life Questionnaire (CQLQ). A CV question, which gave the participants the choice between an ACEI and AIIRA level of cough, was also asked. The CV health states were based on clinical trial data. RESULTS: Respondents ranged in age from 38-81 years (mean = 58.4 years) in the ACEI group, and 31-82 years (mean = 55.6 years) in the AIIRA group. A significant relationship between cough severity and QoL existed for the CQLQ (p = 0.003) and the WHOQoL-Bref (p = 0.025) in the ACEI group. Cough severity was significantly related to difficulty of sleeping (p = 0.009), being self-conscious (p = 0.015), and exhaustion (p = 0.002). The CV analysis for the AIIRA scenario yielded a mean willingness-to-pay of AUS$16.80 per month for those on ACEIs and AUS$16.20 per month for those on AIIRAs. CONCLUSION: Overall, the results from this study illustrate the impact that ACEI-induced cough has on quality of life. Both patient groups were willing to pay over AUS$16 per month to experience effective hypertension control associated with a lower risk of experiencing cough. This suggests that the impact of cough on QoL may be more than previously considered and should be considered when selecting antihypertensive treatment.