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Captopril treatment in hypertensive dialysis patients
Insights
Captopril effectively controlled resistant hypertension in dialysis patients, offering an alternative to surgery. This angiotensin-converting enzyme inhibitor showed sustained benefits with few side effects.
Area of Science:
- Nephrology
- Cardiology
- Pharmacology
Background:
- Arterial hypertension is a common complication in dialysis patients.
- Treatment-resistant hypertension poses significant challenges in this population.
- Bilateral nephrectomy is a surgical option for refractory cases.
Purpose of the Study:
- To evaluate the efficacy and safety of captopril in dialysis patients with treatment-resistant arterial hypertension.
- To assess captopril's role as an alternative to surgical intervention.
Main Methods:
- A study involving 17 dialysis patients with resistant hypertension.
- Treatment with captopril, monitoring blood pressure, plasma renin activity, and adverse reactions.
- Long-term follow-up for efficacy and safety assessment.
Main Results:
- Excellent blood pressure control (diastolic < 95 mmHg) achieved in 59% of patients.
- Captopril was effective as monotherapy in 8 patients.
- Low dosage maintained antihypertensive and angiotensin-converting enzyme blocking effects.
- Acute response correlated with plasma renin activity, but long-term success was observed in low-renin patients.
- Minor adverse reactions (urticaria, bullous exanthema) resolved upon discontinuation.
- Plasma potassium showed minimal increase.
Conclusions:
- Captopril is a valuable therapeutic option for arterial hypertension in dialysis patients.
- It offers a non-surgical alternative for managing treatment-resistant hypertension in this cohort.
- The drug demonstrates a favorable safety profile and sustained efficacy.
Abstract:
Captopril was used for treatment resistant arterial hypertension in 17 dialysis patients. Excellent blood-pressure control with diastolic blood-pressure less than 95 mmHg was obtained in 10 out of 17 patients (59%), with captopril as only drug in 8 patients. Six patients have been treated more than 6 months and 4 patients have been on the treatment for 1 year. The dosage of captopril could be kept low with maintained antihypertensive and angiotensin converting enzyme blocking effects. The acute blood-pressure lowering effect of captopril in dialysis patients was correlated to the initial plasma renin activity (p less than 0.001) but not long-term treatment, which was successful also in several low-renin patients. A few adverse reactions were encountered, e.g. urticaria and bullous exanthema, but all resolved when captopril treatment was stopped. Plasma potassium increased only from 4.8 +/- 0.1 to 5.0 +/- 0.1 mmol/l at the end of 1 month's treatment. Captopril appears to be a valuable drug for treatment of arterial hypertension in dialysis patients and offers an alternative to bilateral nephrectomy for the management of treatment resistant hypertension in these patients.