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Safety and efficacy of chronic therapy with captopril in hypertensive patients: an update
Insights
Captopril effectively controls hypertension but often requires sodium reduction. Many patients experience side effects, necessitating dose adjustments based on renal function to minimize adverse reactions.
Area of Science:
- Cardiology
- Pharmacology
- Nephrology
Background:
- Captopril is an oral angiotensin-converting enzyme inhibitor used for hypertension.
- Many patients have previously uncontrollable high blood pressure.
- Long-term efficacy may require sodium reduction.
Purpose of the Study:
- To evaluate the efficacy and safety of captopril in patients with hypertension.
- To identify adverse reactions and factors influencing their occurrence.
Main Methods:
- Administered captopril to 81 patients with various types of clinical hypertension.
- Monitored blood pressure control, body sodium levels, and adverse events over two years.
Main Results:
- Satisfactory blood pressure control required sodium reduction in over half of patients.
- 46.9% of patients experienced side effects, with 23.4% discontinuing the drug.
- Drug-related adverse reactions included skin rash, taste alteration, pancytopenia, and pemphigus foliaceus.
- Impaired renal function correlated with higher incidence of cutaneous and taste issues.
Conclusions:
- Captopril is effective for hypertension, but requires careful management.
- Adverse reactions are common and can be severe, with some linked to drug class effects and others specific to captopril.
- Dose titration based on renal function may reduce adverse events, particularly in patients with kidney impairment.
Abstract:
Captopril, an orally active angiotensin-converting enzyme inhibitor, has been administered to 81 patients with different types of clinical hypertension. Most of the patients had previously uncontrollable high blood pressure. In order to achieve a satisfactory blood pressure control during long-term captopril therapy, a concomitant decrease in total body sodium was required in more than half of the patients. During our first two years of clinical experience with this new antihypertensive agent, side effects developed in 46.9 per cent of the patients and necessitated the withdrawal of the drug in 23.4 per cent of all patients. Only a few side effects such as hypotensive or syncopal episodes and cold extremities appeared to be due to the chronic blockade of the renin-angiotensin system. The most frequent and the most serious adverse reactions such as skin rash, altered taste, pancytopenia, and pemphigus foliaceus seemed to be specifically drug related. The incidence of cutaneous and taste problems was markedly higher in patients with impaired renal function in whom retention of captopril has been previously demonstrated. This suggests that the occurrence of adverse reactions to captopril could be lowered in the future by using smaller daily doses and by titrating them according to the renal function.