[Captopril in treatment-resistant hypertension (author's transl)]

Abstract

26 patients with severe hypertension (10 essential, 9 renal parenchymatous, 7 renovascular) and a mean age of 42 years were treated with the new oral converting enzyme inhibitor captopril (SQ 14225). During the initial phase with a standardized triple therapy (STT) consisting of propranolol (maximum 320 mg/day), hydralazine (maximum 200 mg/day) and hydrochlorothiazide (maximum 100 mg/day) or furosemide (maximum 250 mg/day) mean systolic and diastolic blood pressure values remained almost unchanged (184 +/- 32/111 +/- 17 mm Hg to 179 +/- 34/112 +/- 19 mm Hg), indicating true therapy resistance to conventional antihypertensive therapy. After discontinuing each antihypertensive agent captopril was then titrated from 3 X 25 mg/day to a maximum of 4 X 150 mg/day. Mean systolic and diastolic blood pressure values 2, 4, 8, and 16 weeks after starting captopril were 154/95, 155/97, 149/93 and 143/91 mm Hg. The corresponding mean captopril doses were 242, 280, 325 and 299 mg daily. During captopril medication mean systolic and diastolic blood pressure values were significantly lower (p less than 0.05 to p less than 0.005) than during STT. Throughout the observation period of 16 weeks only 15% of the cases were on monotherapy with captopril whereas 62% needed the addition of a diuretic (hydrochlorothiazide or furosemide). In 23% of the cases even the combination of captopril and diuretic was insufficient and thus propranolol was added as a third drug. The side effects observed were 1 case with renal water and fluid retention and with reversible skin rash and 1 with pruritus. The results demonstrate that captopril has good blood pressure lowering activity in patients with treatment-resistant hypertension. However, in the majority of our cases the addition of a diuretic was necessary. Finally, some patients required a beta-blocker as a third drug.