Captopril in hypertensive black men in southern Africa

A group of 55 black men with mild or moderate hypertension who were being treated with methyldopa, prazosin, and a thiazide diuretic in combination with sotalol, were studied before and after changing their treatment to captopril and a thiazide diuretic. The level of blood pressure control was similar in the 11 men with mild hypertension but the 44 men with moderate hypertension were less well controlled with captopril and a thiazide diuretic. In the men with moderate hypertension the mean increase in the systolic blood pressure after the change in treatment was 4.7 mmHg (not significant) and in the diastolic pressure 6.2 mmHg (P less than 0.02). The mean blood pressure was higher during treatment with captopril in 37 men and lower in 18 men (P = 0.01). Thirty-seven men found both regimens acceptable and 33 of these men preferred the captopril regimen; however, 15 men said they did not like the captopril regimen while only 4 men did not like the methyldopa/prazosin regimen (P less than 0.01). Side-effects from the captopril regimen were reported by 18 of the men and from the methyldopa/prazosin regimen by 6 men (P less than 0.02). It was concluded that the captopril/thiazide regimen was less effective than the methyldopa/prazosin/sotalol/thiazide regimen for the control of moderate hypertension in this population of black men. Although the men who liked both regimens preferred the captopril regimen, that regimen was associated with significantly more side-effects and was disliked by more of the men than was the methyldopa/prazosin regimen.