Saluretics and converting-enzyme blockade in the treatment of resistant hypertension

Blockade of the actions of the renin-angiotensin-aldosterone axis by inhibition of the angiotensin-converting enzyme with captopril is a new tool in the field of hypertension. As treatment with captopril makes pressure control volume-dependent, the addition of a saluretic is considered the best choice if an additional hypotensive agent is needed. The reason for and experience of the use of captopril in combination with saluretics for treatment of severe hypertension is reviewed. Published results indicate that captopril alone is insufficient, but as many as a third of the patients with previously uncontrollable hypertension manage well when a saluretic is added. Only one in six remains uncontrolled despite the addition of several other hypotensive agents. These observations apply to both essential and secondary forms of hypertension.