Low-dose captopril for the treatment of mild to moderate hypertension. I. Results of a 14-week trial. Veterans Administration Cooperative Study Group on Antihypertensive Agents

Abstract

We randomized 495 men with uncomplicated hypertension (diastolic BP, 92 to 109 mm Hg) to one of five captopril regimens at the following dosages: 12.5 mg three times a day, 25 mg three times a day, 37.5 mg twice daily, 50 mg three times a day, or placebo three times a day. After seven weeks, BP reduction with each captopril dose was greater than in the placebo group, averaging 10.2 to 14.2/8.6 to 10.5 mm Hg. Captopril, 37.5 mg/day, was as effective as 150 mg/day. Hydrochlorothiazide, 25 mg twice daily, was added for seven more weeks to all patients receiving placebo and to two thirds of those randomized to captopril therapy. Blood pressure reduction averaged 12.0/8.7 mm Hg in those receiving hydrochlorothiazide alone and 24.9 to 26.4/14.4 to 17.3 mm Hg in those receiving a combination of hydrochlorothiazide and captopril. Added hydrochlorothiazide greatly enhanced the antihypertensive response. The 15 terminations (4.3%) related to captopril were not life threatening.

Conclusion: Captopril treatment of uncomplicated hypertension may be initiated with 37.5 mg/day--half the currently recommended dose.