Abstract
Twenty-four patients with moderate to severe hypertension were treated for four weeks with captopril, an oral inhibitor of angiotensin-converting enzyme. The fall in blood pressure with captopril alone correlated with pretreatment plasma renin activity. The effect of adding either hydrochlorothiazide or propranolol to the captopril treatment was then studied. The addition of hydrochlorothiazide to captopril produced a dose-dependent fall in blood pressure. At the higher dose of the diuretic this fall in blood pressure correlated with weight loss, suggesting that when the diuretic-induced compensatory rise in angiotensin II is prevented by captopril the fall in blood pressure becomes dependent on loss of sodium and water. In contrast, the addition of propranolol to captopril produced no further fall in blood pressure, suggesting that inhibition of angiotensin-converting enzyme prevents the blood pressure lowering effect of propranolol. This may have implications for the mechanism whereby beta-blockers alone lower blood pressure. These contrasting effects of hydrochlorothiazide and propranolol in the presence of captopril indicate that in patients whose hypertension is not controlled by captopril alone the addition of increasing doses of diuretic is likely to control the blood pressure. The addition of a beta-blocker, however, is less likely to be effective.
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Selected References
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- Atkinson A. B., Brown J. J., Lever A. F., Robertson J. I. Combined treatment of severe intractable hypertension with captopril and diuretic. Lancet. 1980 Jul 19;2(8186):105–108. doi: 10.1016/s0140-6736(80)90001-x. [DOI] [PubMed] [Google Scholar]
- Atkinson A. B., Robertson J. I. Captopril in the treatment of clinical hypertension and cardiac failure. Lancet. 1979 Oct 20;2(8147):836–839. doi: 10.1016/s0140-6736(79)92186-x. [DOI] [PubMed] [Google Scholar]
- Bravo E. L., Tarazi R. C. Converting enzyme inhibition with an orally active compound in hypertensive man. Hypertension. 1979 Jan-Feb;1(1):39–46. doi: 10.1161/01.hyp.1.1.39. [DOI] [PubMed] [Google Scholar]
- Brunner H. R., Waeber B., Wauters J. P., Turin G., McKinstry D., Gavras H. Innappropriate renin secretion unmasked by captopril (SQ 14 225) in hypertension of chronic renal failure. Lancet. 1978 Sep 30;2(8092 Pt 1):704–707. doi: 10.1016/s0140-6736(78)92703-4. [DOI] [PubMed] [Google Scholar]
- Case D. B., Atlas S. A., Laragh J. H., Sealey J. E., Sullivan P. A., McKinstry D. N. Clinical experience with blockade of the renin-angiotensin-aldosterone system by an oral converting-enzyme inhibitor (SQ 14,225, captopril) in hypertensive patients. Prog Cardiovasc Dis. 1978 Nov-Dec;21(3):195–206. doi: 10.1016/0033-0620(78)90025-7. [DOI] [PubMed] [Google Scholar]
- Drayer J. I., Keim H. J., Weber M. A., Case D. B., Laragh J. H. Unexpected pressor responses to propranolol in essential hypertension. An interaction between renin, aldosterone and sympathetic activity. Am J Med. 1976 May 31;60(6):897–903. doi: 10.1016/0002-9343(76)90911-6. [DOI] [PubMed] [Google Scholar]
- Gavras H., Brunner H. R., Turini G. A., Kershaw G. R., Tifft C. P., Cuttelod S., Gavras I., Vukovich R. A., McKinstry D. N. Antihypertensive effect of the oral angiotensin converting-enzyme inhibitor SQ 14225 in man. N Engl J Med. 1978 May 4;298(18):991–995. doi: 10.1056/NEJM197805042981803. [DOI] [PubMed] [Google Scholar]
- Ibsen H., Leth A., Hollnagel H., Kappelgaard A. M., Nielsen M. D., Giese J. Renin--angiotensin system in mild essential hypertension. The functional significance of angiotensin II in untreated and thiazide-treated hypertensive patients. Clin Sci Mol Med Suppl. 1978 Dec;4:319s–321s. doi: 10.1042/cs055319s. [DOI] [PubMed] [Google Scholar]
- Johnston C. I., Millar J. A., McGrath B. P., Matthews P. G. Long-term effects of captopril (SQ14 225) on blood-pressure and hormone levels in essential hypertension. Lancet. 1979 Sep 8;2(8141):493–496. doi: 10.1016/s0140-6736(79)91552-6. [DOI] [PubMed] [Google Scholar]
- Lederle R. M., Klaus D., Braun B. Captopril bei essentieller Hypertonie. Dtsch Med Wochenschr. 1980 Sep 19;105(38):1307–1312. doi: 10.1055/s-2008-1070861. [DOI] [PubMed] [Google Scholar]
- Leonetti G., Terzoli L., Sala C., Bianchini C., Sernesi L., Zanchetti A. Relationship between the hypotensive and renin-stimulating actions of diuretic therapy in hypertensive patients. Clin Sci Mol Med Suppl. 1978 Dec;4:307s–309s. doi: 10.1042/cs055307s. [DOI] [PubMed] [Google Scholar]
- MacGregor G. A., Markandu N. D., Roulston J. E., Jones J. C. Essential hypertension: effect of an oral inhibitor of angiotensin-converting enzyme. Br Med J. 1979 Nov 3;2(6198):1106–1109. doi: 10.1136/bmj.2.6198.1106. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Roulston J. E., MacGregor G. A. Measurement of plasma renin activity by radioimmunoassay after prolonged cold storage. Clin Chim Acta. 1978 Aug 15;88(1):45–48. doi: 10.1016/0009-8981(78)90147-x. [DOI] [PubMed] [Google Scholar]
- White N. J., Rajagopalan B., Yahaya H., Ledingham J. G. Captopril and frusemide in severe drug-resistant hypertension. Lancet. 1980 Jul 19;2(8186):108–110. doi: 10.1016/s0140-6736(80)90002-1. [DOI] [PubMed] [Google Scholar]
- van Brummelen P., Willemze R., Tan W. D., Thompson J. Captopril-associated agranulocytosis. Lancet. 1980 Jan 19;1(8160):150–150. doi: 10.1016/s0140-6736(80)90629-7. [DOI] [PubMed] [Google Scholar]