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The antihypertensive effect of captopril in severe essential, renovascular, renal and transplant renovascular hypertension

Die antihypertensive Wirkung von Captopril bei schwerer essentieller, renovaskulärer, renaler und Transplantat-renovaskulärer Hypertonie

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Summary

The acute and long-term (6 months) effects of captopril (C) were studied in 23 patients with previously uncontrolled severe (DBP>120 mmHg) hypertension of different origin: essential (EH)n=10, renovascular (RVH)n=9, and renal (RH)n=4. In addition, four patients were treated with renal transplant artery stenosis and hypertension (TRVH), refractory to conventional therapy. Before treatment supine blood pressure (BP, mmHg) averaged: 205/131 (EH), 204/124 (RVH), 207/132 (RH) and 194/117 (TRVH). All patients received diuretics and other antihypertensive drugs, the dosages of which are expressed in arbitrary equivalent units (U) per day (UD=diuretics; UA=other antihypertensive drugs). Antihypertensive therapy before study:UD: EH 1.6; RVH 1.0;UA: EH 7.3; RVH 5.5. After admission, C dosage was increased from 25 mg to a maximum of 150 mg t.i.d. Antihypertensive treatment was reduced as far as possible. DBP decrease after 25 mg C was related to pretreatment PRA in RVH only. After 3 months of C treatment, BP decreased to 190/116 in EH and 145/89 in RVH (EH vs RVHP<0.01), 158/98 in RH, and 154/90 in TRVH. After 6 months, BP response was maintained in RH and TRVH. BP increased slightly in RVH to 158/102 mmHg, mainly because of impaired renal function in three patients with bilateral renovascular disease. In EH,BP decreased to 167/109, since three non-responders were taken out of the group. After 6 months, EH still received higher dosages of antihypertensive drugs than RVH. Acute and chronic hypotensive effects of C were not significantly correlated. Side-effects occurred in five patients: skin rash and pruritus [2], taste disturbances [1], proteinuria [1], and acute renal failure in one patient with TRVH. In our hands, captopril in combination with diuretics was significantly more potent in severe RVH than in EH. Dosages and side-effects of other antihypertensive drugs could be markedly reduced in most patients, which may improve long-term drug compliance.

Zusammenfassung

Akut- und Langzeitwirkungen (6 Monate) von Captopril (C) wurden bei 23 Patienten mit schwerer, unbehandelbarer (diast. Blutdruck >120 mmHg) Hypertonie unterschiedlicher Ätiologie untersucht: Essentielle (EH)n=10, renovaskuläre (RVH)n=9 und renale (RH)n=4, Hypertonie. Zusätzlich wurden 4 Patienten mit therapie-refraktärer Hypertonie und Nierentransplantatarterienstenose (TRVH) behandelt. Der Blutdruck (BP, mmHg) vor Therapie betrug im Mittel: 205/131 (EH), 204/124 (RVH), 207/132 (RH), 194/117 (TRVH). Alle Patienten erhielten Diuretika sowie andere Antihypertensiva, deren Dosierungen in Äquivalenzeinheiten (U) pro Tag angegeben werden (UD=Diuretika; UA=andere Antihypertensiva). Antihypertensive Therapie vor der Untersuchung:UD: EH 1.6; RVH 1.0;UA: EH 7.3; RVH 5.5. Nach der stationären Aufnahme erfolgte eine C-Therapie mit steigender Dosis von 25 mg auf maximal 150 mg dreimal/Tag. Die übrige antihypertensive Behandlung wurde so weit wie möglich reduziert. Der diastolische BP-Abfall nach 25 mg C stand nur bei RVH in Beziehung zur peripheren Reninaktivität (PRA). Nach 3 Monaten C-Therapie erfolgte ein BP-Abfall auf 190/116 bei EH und auf 145/89 bei RVH (P<0.01), auf 158/98 bei RH und auf 154/90 bei TRVH. Nach 6 Monaten war die Blutdrucksenkung bei RH und TRVH unverändert. In der Gruppe mit RVH kam es zu einem geringen BP-Anstieg auf 158/102, welcher vorwiegend durch die Nierenfunktionsverschlechterung bei 3 Patienten mit bilateraler Nierenarterienstenose bedingt war. In der Gruppe mit EH fiel der BP auf 167/109, da 3 „non-responder“ aus der Gruppe herausgenommen wurden. Nach 6 Monaten erhielt die Gruppe mit EH höhere Dosierungen von Antihypertensiva als Patienten mit RVH. Akut- und Langzeiteffekte von C waren nicht signifikant miteinander korreliert. Nebenwirkungen traten bei 5 Patienten auf: Hautexanthem und Juckreiz (2), Geschmacksstörungen (1), Proteinurie (1), akutes Nierenversagen bei einem Patienten mit TRVH. In der vorliegenden Untersuchung war Captopril in Kombination mit Diuretika bei schwerer RVH deutlich wirksamer als bei schwerer EH. Die Dosierung und Nebenwirkungen anderer Antihypertensiva konnte bei den meisten Patienten deutlich vermindert werden. Dadurch wird wahrscheinlich die Langzeit-Kompliance verbessert.

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References

  1. Ondetti MA, Rubin B, Cushman DW (1977) Design of specific inhibitors of angiotensin-converting enzyme: new class of orally active antihypertensive agents. Science 196:441–444

    Google Scholar 

  2. Brunner HR, Gavras H, Waeber B, Kershaw GR, Turnini GA, Vukovich RA, McKinstry DN, Gavras I (1979) Oral angiotensin-coverting enzyme inhibitor in long-term treatment of hypertensive patients. Ann Intern Med 90:19–23

    Google Scholar 

  3. Gavras H, Brunner HR, Turini GA, Kershaw GR, Tifft CP, Cuttelod S, Gavras I, Vukovich RA, McKinstry DN (1978) Antihypertensive effect of the oral angiotensin converting-enzyme inhibitor SQ 14225 in man. N Engl J Med 298:991–995

    Google Scholar 

  4. Lederle RM, Klaus D, Braun B (1980) Captopril bei essentieller Hypertonie. Dtsch Med Wochenschr 105:1307–1312

    Google Scholar 

  5. Overlack A, Stumpe KO, Hech I, Krück F (1980) Neues Prinzip in der Langzeitbehandlung der essentiellen Hypertonie. Dtsch Med Wochenschr 105:505–509

    Google Scholar 

  6. Huang CM, Del Greco F, Quintanilla A, Molteni A (1981) Comparison of antihypertensive effect of captopril and propranolol in essential hypertension. JAMA 245:478–482

    Google Scholar 

  7. Studer A, Lüscher T, Siegenthaler W, Vetter W (1981) Captopril in various forms of severe therapy-resistant hypertension. Klin Wochenschr 59:59–67

    Google Scholar 

  8. Ferguson RK, Vlasses PH, Koplin JR, Shirinian A, Burke JF, Alexander JC (1980) Captopril in severe treatment-resistant hypertension. Am Heart J 99:579–585

    Google Scholar 

  9. Zweifler AJ, Julius S, Nicholls MG (1981) Efficacy of an oral angiotensin-converting enzyme inhibitor (captopril) in severe hypertension. Arch Intern Med 141:907–910

    Google Scholar 

  10. Captopril: Benefits and risks in severe hypertension (1980) Lancet II:108–110 (Editorial)

  11. Fagard RH, Amery AK, Lijnen PJ, Reybrouck TM (1980) Comparative study of an angiotensin-II analog and a converting-enzyme inhibitor. Kidney Int 17:647–653

    Google Scholar 

  12. Waeber B, Brunner HR, Brunner DB, Curtet AL, Turini GA, Gavras H (1980) Discrepancy between antihypertensive effect and angiotensin converting enzyme inhibition by captopril. Hypertension 2:236–242

    Google Scholar 

  13. Overlack A, Stumpe KO, Kühnert M, Kolloch R, Ressel C, Heck I, Krück F (1981) Evidence for participation of kinins in the antihypertensive effect of converting enzyme inhibition. Klin Wochenschr 59:69–74

    Google Scholar 

  14. Oelkers W, Schoeneshoefer M, Blümel A (1974) Effects of progesterone and four synthetic progestagens on sodium balance and the renin-aldosterone system in man. J Clin Endocrinol Metab 39:882–890

    Google Scholar 

  15. Swartz SL, Moore TJ, Dluhy RG, Hollenberg NK, Levine L, Koletsky RJ, LeBoff MS, Williams GH (1980) Captopril increases prostaglandin production. 7th Sci Meeting of the Int Soc of Hypertension, New Orleans, p 131

  16. White NJ, Yahaya H, Rajagopalan B, Ledingham JGG (1980) Captopril and furosemide in severe drug-resistant hypertension. Lancet II:108–110

    Google Scholar 

  17. Atkinson AB, Lever AF, Brown JJ, Robertson JIS (1980) Combined treatment of severe intractable hypertension with captopril and diuretic. Lancet II: 105–108

    Google Scholar 

  18. Staessen J, Fagard R, Lijenen P, Verschueren LJ, Amery A (1980) Beta blockade during captopril treatment for hypertension. N Engl J Med 303:1121–1122

    Google Scholar 

  19. Farrow PR, Wilkinson R (1979) Reversible renal failure during treatment with captopril. Br Med J 1:1680

    Google Scholar 

  20. Collste P, Haglund K, Lundgren G, Magnusson G, Östman J (1979) Reversible renal failure during treatment with captopril. Br Med J 2:612–613

    Google Scholar 

  21. Hoorntje SJ, Weening JJ, The Th, Kallenberg CGM, Donker AJM, Hoedemaeker PJ (1980) Immune-complex glomerulopathy in patients treated with captopril. Lancet I:1212–1215

    Google Scholar 

  22. Rosendorff C, Milne FJ, Levy H, Ninnin DT, Lewin JR (1980) Nephrotic syndrome during captopril therapy. Kidney Int 18:534

    Google Scholar 

  23. Staessen J, Fagard R, Lijnen P, Amery A (1980) Captopril and agranulocytosis. Lancet I:926–927

    Google Scholar 

  24. Hall JE, Guyton AC, Jackson TE, Coleman TG, Lohmeier TE, Trippodo NC (1977) Control of glomerular filtration rate by renin-angiotensin system. Am J Physiol 233: F 366 - F 372

    Google Scholar 

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  1. Abt. für Innere Medizin mit Schwerpunkt Endokrinologie und Abt. für Nephrologie der Medizinischen Klinik und Poliklinik, Klinikum Steglitz, Freie Universität Berlin, Germany

    G. Schwietzer & W. Oelkers

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  1. G. Schwietzer
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Schwietzer, G., Oelkers, W. The antihypertensive effect of captopril in severe essential, renovascular, renal and transplant renovascular hypertension. Klin Wochenschr 60, 839–846 (1982). https://doi.org/10.1007/BF01728350

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