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Long-term effect of captopril on kidney function in various forms of hypertension
Insights
Captopril therapy in severe hypertension can increase serum creatinine, particularly in renovascular hypertension patients. Renal function decline was more significant with bilateral renovascular disease and fibromuscular dysplasia.
Area of Science:
- Nephrology
- Cardiology
- Pharmacology
Background:
- Severe hypertension poses significant risks to renal function.
- Angiotensin-converting enzyme (ACE) inhibitors like captopril are used to manage hypertension.
- Long-term effects of captopril on kidney function in diverse hypertensive populations require detailed study.
Purpose of the Study:
- To investigate the long-term impact of captopril on renal function, specifically serum creatinine levels.
- To compare these effects across different types of severe hypertension: essential, renovascular, and renal parenchymatous.
- To identify patient subgroups at higher risk for captopril-induced renal changes.
Main Methods:
- Serum creatinine was monitored in 76 severe hypertension patients over 3 years.
- Patients were categorized into essential (n=37), renovascular (n=20), and renal parenchymatous (n=19) hypertension groups.
- Subgroup analyses were performed based on renovascular disease laterality, origin, and initial plasma renin activity (PRA).
Main Results:
- Captopril treatment led to increased serum creatinine in all hypertension groups, indicating a reduction in renal function.
- These increases were most pronounced in patients with renovascular hypertension, with statistically significant and progressive creatinine rise over time.
- Renal function deterioration was more severe in bilateral renovascular disease and fibromuscular dysplasia compared to arteriosclerotic origins; significant differences were also noted based on initial PRA levels.
Conclusions:
- Captopril therapy, while effective for blood pressure control, can adversely affect renal function, especially in patients with renovascular hypertension.
- Patients with renovascular hypertension, particularly those with bilateral disease or fibromuscular dysplasia, require close renal function monitoring during captopril treatment.
- The study highlights the importance of considering the specific etiology of hypertension when assessing the renal safety of ACE inhibitors.
Abstract:
To study long-term effects of captopril on renal function in patients with various forms of severe hypertension, serum creatinine values were monitored in 76 patients under captopril therapy over a period of up to 3 years. Three different groups were formed: patients with essential hypertension (n = 37); patients with renovascular hypertension (n = 20); patients with renal parenchymatous hypertension (n = 19). In each of the three groups reduction in blood pressure was accompanied by increases in serum creatinine. However, both changes were more pronounced in patients with renovascular hypertension. In this group only the rise in creatinine was statistically significant and showed a slight progression with duration of captopril treatment. Group specific analysis revealed that the increase was smaller in patients with unilateral (n = 16) renovascular disease than in those with bilateral (n = 4) involvement, but in the former it was still significantly higher than in patients with essential or renal parenchymatous hypertension. Separation of patients according to the underlying disease of renovascular hypertension showed that renal function deteriorated less in patients with arteriosclerotic origin (n = 10) than in those with fibromuscular dysplasia (n = 8). Statistical evaluation of subjects with renovascular and essential hypertension still revealed significant differences in creatinine when the patients with initial plasma renin activity (PRA) below and above 6 ng/ml X 3 h were compared separately. A significant correlation (r = 0.73; P less than 0.05) between blood pressure reduction and creatinine changes was obtained only for patients with renovascular hypertension.(ABSTRACT TRUNCATED AT 250 WORDS)