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Long-term antihypertensive therapy with captopril
Insights
Captopril, an angiotensin-converting enzyme inhibitor, demonstrated sustained effectiveness and safety in long-term hypertension management. This study found no drug tolerance, with manageable side effects over four years.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Hypertension necessitates lifelong treatment, making long-term drug efficacy and safety crucial.
- Investigating the long-term effects of captopril is vital for its continued therapeutic use.
Purpose of the Study:
- To assess the continuing effectiveness and safety of captopril in hypertensive patients over extended periods.
- To evaluate the development of drug tolerance and the incidence of side effects during long-term captopril therapy.
Main Methods:
- A cohort of 7103 hypertensive patients received captopril, with 4397 treated for 3 months to 4 years.
- Long-term patients included those with mild, moderate, severe essential, and renovascular hypertension, often co-treated with diuretics.
- Data collected through repeated examinations to monitor blood pressure control, drug tolerance, side effects, and biochemical parameters.
Main Results:
- No significant drug tolerance was observed in patients on long-term captopril and diuretic therapy.
- Common early side effects like rash and taste disturbances were not problematic long-term; neutropenia was rare.
- Proteinuria occurred in 1.0% of patients, primarily those with pre-existing renal disease on high doses, and was usually reversible.
Conclusions:
- Captopril provides sustained blood pressure control without tolerance in long-term hypertension management.
- The overall 4-year cumulative discontinuance rate for side effects was 11.6%, comparing favorably to other antihypertensives.
- Captopril is a safe and effective option for prolonged hypertension treatment, with manageable side effect profiles.
Abstract:
Most forms of hypertension require life-long treatment; thus, it is important to determine the continuing effectiveness and safety of any new therapeutic agent. While participating in various investigational studies, 7103 hypertensive patients received captopril, of whom 4397 were treated for 3 months to 4 years. The 4-year patients included 2498 with mild or moderate essential hypertension (diastolic pressure less than 120 mm Hg), 893 with severe essential hypertension, and 517 with renovascular hypertension. Repeated examinations of these long-term therapy patients, the majority of whom also were receiving a diuretic, indicated no drug tolerance to the combination, i.e., there was continuing control of the blood pressure without significant increases in dosage or addition of other drugs. Side-effects occurring during the first few months of captopril administration (rash, taste disturbances, and, rarely, neutropenia) were not a problem during prolonged therapy. A few patients (70/7,103, or 1.0%) developed proteinuria, usually reversible and seldom associated with any deterioration of renal function. The proteinuria occurred most often in patients who had preexisting renal disease and were receiving high doses of the drug. There were no significant changes in key biochemical parameters. A total of 230 patients discontinued treatment for failure to maintain adequate blood pressure reduction, and 397 for side-effects. The estimated 4-year cumulative frequency of drug discontinuance for side-effects was 11.6% (life table method), which compares favorably with other classes of antihypertensive drugs.(ABSTRACT TRUNCATED AT 250 WORDS)