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Deterioration of renal function in hypertensive patients with scleroderma despite blood pressure normalization with
Insights
Angiotensin-converting enzyme (ACE) inhibitors like captopril can help manage scleroderma hypertension. However, this study shows they do not prevent severe kidney damage or multivisceral complications in systemic sclerosis patients.
Area of Science:
- Nephrology
- Rheumatology
- Pharmacology
Background:
- Systemic sclerosis (scleroderma) often presents with severe hypertension and renal compromise.
- Angiotensin-converting enzyme (ACE) inhibitors are a potential treatment for hypertension in these patients.
Observation:
- Three patients with progressive systemic sclerosis and severe hypertension received captopril.
- Despite blood pressure control, all patients experienced renal function deterioration requiring hemodialysis.
- No significant improvement in skin lesions was noted during captopril treatment.
Findings:
- ACE inhibition with captopril effectively controlled blood pressure in scleroderma patients.
- Renal function continued to decline, necessitating hemodialysis in all cases.
- Captopril did not prevent the progression of multivisceral vascular lesions.
Implications:
- While ACE inhibitors can manage hypertension in scleroderma, they may not halt disease progression or prevent renal failure.
- Further research is needed to explore alternative or adjunctive therapies for scleroderma-associated renal and vascular complications.
Abstract:
The orally active angiotensin-converting enzyme inhibitor captopril was administered for up to 11 weeks to three patients with progressive systemic sclerosis presenting with hypertension and plasma creatinine levels of 3.1, 7.2 and 10.4 mg/100 ml. Only one patient had malignant phase hypertension. In this patient a diuretic had to be added to captopril in order to keep blood pressure under control. Despite sustained blood pressure control during captopril administration, renal function deteriorated and hemodialysis treatment had to be started in all patients. Up to that time no substantial improvement in skin lesions was observed. During the period of dialysis, blood pressure was normal in all patients even though administration of captopril was discontinued. All three patients died of respiratory failure while on chronic hemodialysis for 3 to 4 weeks. These observations confirm that angiotensin-converting enzyme inhibition may be helpful in controlling blood pressure of patients with scleroderma. However, in contrast to some earlier reports, they also indicate that converting enzyme inhibition does not always prevent the multivisceral vascular lesions of scleroderma.