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[Captopril in the treatment of essential hypertension (author's transl)]
Insights
Captopril effectively lowers blood pressure in patients with essential hypertension. While some achieved normal levels, others required additional treatment, indicating varying responses to this angiotensin-converting enzyme inhibitor.
Area of Science:
- Cardiology
- Pharmacology
Context:
- Essential hypertension is a prevalent cardiovascular condition.
- WHO grades I and II represent mild to moderate hypertension.
- Angiotensin-converting enzyme (ACE) inhibitors are a key class of antihypertensive drugs.
Purpose:
- To evaluate the antihypertensive efficacy of captopril in patients with essential hypertension.
- To assess the impact of captopril on plasma renin activity and aldosterone levels.
- To investigate the role of baseline blood pressure and renin activity in treatment response.
Summary:
- Captopril normalized blood pressure in 11 of 19 patients with essential hypertension (WHO grade I/II) within 12 weeks at 50-150 mg daily.
- Eight patients with higher baseline pressures and lower renin activity showed reduced, but not normalized, blood pressure, even with added propranolol.
- Captopril increased plasma renin activity and decreased plasma aldosterone, consistent with angiotensin II level reduction due to ACE inhibition.
Impact:
- Captopril demonstrates significant antihypertensive effects, particularly in milder hypertension.
- Understanding baseline renin activity may predict treatment response to ACE inhibitors.
- Further investigation is needed for the observed normochromic anemia in a subset of patients.
Abstract:
The antihypertensive effect of captopril was tested on 19 patients with essential hypertension, WHO grade I or II. In 11 patients blood pressure levels returned to normal over an observation period of 12 weeks at a dose of 3 C 50-150 mg daily (group A). In eight patients with grade II hypertension the absolute blood-pressure reduction was the same, but did not reach normal levels (group B). Although additional intake of propranolol, at a dose of 3 X 40 mg daily, achieved further reduction, normal pressures were still not attained. Initial blood pressure levels were higher and plasma-renin activity lower in patients of group B than of group A. There was a definite rise in plasma-renin activity with captopril, but corresponding to the suppression of plasma-renin in severe hypertension it was less. There was a fall in plasma-aldosterone levels, corresponding to a reduced angiotensin II level as a result of inhibition of the converting enzyme. The fall in plasma-aldosterone activity was less in severe hypertension, although there was the same inhibition of converting enzyme activity in both groups. Normochromic anaemia was noted in three patients, requiring further observation and explanation. No patient developed orthostatic hypotension or reflex tachycardia.