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Long-term effects of captopril on renal function in hypertensive patients
Insights
Captopril effectively lowered blood pressure in patients with severe hypertension resistant to other treatments. Long-term use showed improved renal function, though rare adverse events like nephrotic syndrome occurred.
Area of Science:
- Nephrology
- Cardiology
- Pharmacology
Background:
- Severe hypertension often requires multifaceted treatment strategies.
- Patients with resistant hypertension may have limited therapeutic options.
- Captopril is an angiotensin-converting enzyme (ACE) inhibitor used to treat high blood pressure.
Purpose of the Study:
- To investigate the efficacy and renal effects of captopril in patients with severe, treatment-resistant hypertension.
- To assess both short-term and long-term impacts of captopril on blood pressure and renal function.
Main Methods:
- A study involving 10 patients with severe hypertension refractory to prior therapies.
- Patients received captopril (up to 450 mg/day) in addition to existing diuretics and beta-blockers.
- Glomerular filtration rate (GFR) and para-aminohippuric acid clearance (CPAH) were measured before and during captopril treatment (short-term and long-term).
Main Results:
- Short-term captopril treatment reduced mean blood pressure by 15.5% with variable effects on renal function.
- Long-term therapy led to a significant increase in para-aminohippuric acid clearance (17%, p<0.02) and a non-significant rise in glomerular filtration rate (9%).
- One patient developed captopril-induced nephrotic syndrome, causing a significant decline in GFR and CPAH; another experienced a transient rise in serum creatinine.
Conclusions:
- Captopril demonstrates effectiveness in managing severe, resistant hypertension.
- Long-term captopril administration can improve renal hemodynamics in this patient population.
- Close monitoring for potential adverse renal effects, such as nephrotic syndrome, is crucial during captopril therapy.
Abstract:
The effect of captopril up to 450 mg/day on blood pressure and renal function were investigated during sustained treatment of 10 patients whose severe hypertension had not responded to previous therapy. All the patients were kept on diuretics and most of them on beta-blockers, too. A control determination of glomerular filtration rate (GFR) and para-aminohippuric acid clearance (CPAH) was performed during the prior treatment. The effect of the addition (or substitution) of captopril were assessed after an average of 25 days (short-term) and 26 weeks (long-term). Short-term treatment produced a 15.5% decrease in mean blood pressure and interindividually variable effects on renal function. On average GFR was somewhat lower and CPAH slightly higher than the control values (not significant). This pattern is quite similar to the effects of most other antihypertensive drugs. On long-term therapy GFR rose by a mean of 9% (NS) and CPAH by 17% (p less than 0.02). However, in a patient who developed a captopril-induced nephrotic syndrome, GFR dropped to 56% and CPAH to 50% of the control values. In another patient a transient rise in serum creatinine accompanied a severe drug reaction.