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Captopril withdrawal after chronic therapy

P H Vlasses, H Koffer, R K Ferguson

    Clinical and Experimental Hypertension
    |January 1, 1981
    PubMed
    Summary
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    Abruptly stopping captopril, an angiotensin converting enzyme inhibitor, led to gradual blood pressure increases in hypertensive patients. Reinstituting the drug effectively lowered blood pressure, indicating no tolerance developed.

    Area of Science:

    • Cardiology
    • Pharmacology

    Background:

    • Antihypertensive drug withdrawal can cause sudden blood pressure spikes.
    • Captopril is an orally active angiotensin converting enzyme (ACE) inhibitor used for hypertension.

    Purpose of the Study:

    • To investigate the effects of abrupt captopril withdrawal in patients with moderate to severe hypertension.
    • To assess blood pressure changes and hormonal responses following cessation of captopril therapy.

    Main Methods:

    • Six patients with hypertension had captopril withdrawn from their regimen while continuing other antihypertensives.
    • Blood pressure, plasma renin activity, plasma aldosterone, serum angiotensin II, and plasma catecholamine levels were monitored.

    Main Results:

    • A gradual increase in blood pressure was observed in all patients post-captopril withdrawal (from 135/92 to 164/111 mm Hg).

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  • No symptomatic "rebound" hypertension occurred.
  • Biochemical changes included decreased plasma renin activity, increased plasma aldosterone and serum angiotensin II, with unchanged plasma catecholamines.

    • Conclusions:

    • Cessation of captopril leads to predictable hormonal changes consistent with the reversal of ACE inhibition.
    • Blood pressure elevation after captopril withdrawal was gradual and asymptomatic in this cohort.
    • Reintroduction of captopril effectively reduced blood pressure, suggesting no development of tolerance after chronic use.