[Severe first dose reaction after administration of captopril to patients with carotid artery stenosis]

During recent years, ACE inhibitors have been employed to an increasing extent in the long-term treatment of arterial hypertension. As part of the investigation of arterial hypertension, the captopril test, with administration of a small oral dose of captopril and registration of the blood pressure and pulse during the subsequent period, is employed. During this test, two cases of marked fall in blood pressure accompanied by symptoms of inadequate cerebral circulation were observed. Both of these patients were subsequently submitted to digital subtraction angiography of the vessels of the neck and both found to have unilateral stenosis of the carotid artery. It is concluded that, particularly in elderly hypertensive patients, ACE inhibitor treatment should always be initiated during controlled conditions. Stethoscopic examination of the carotid arteries should always be performed.