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. 1983 Mar 12;286(6368):832–834. doi: 10.1136/bmj.286.6368.832

Factors related to first dose hypotensive effect of captopril: prediction and treatment.

G P Hodsman, C G Isles, G D Murray, T P Usherwood, D J Webb, J I Robertson
PMCID: PMC1547159  PMID: 6403103

Abstract

The blood pressure response to the first dose of captopril (6.25 mg, 12.5 mg, or 25 mg) was measured in 65 treated, severely hypertensive patients. Mean supine blood pressure was 187/108 mm Hg immediately before captopril was given. Twenty one patients experienced a fall in supine systolic pressure greater than 50 mm Hg, including five whose pressure fell more than 100 mm Hg and two whose pressure fell more than 150 mm Hg. Six patients developed symptoms of acute hypotension, including dizziness, stupor, dysphasia, and hemiparesis. Percentage reductions in blood pressure were greatest in those with secondary hypertension (p less than 0.05), high pretreatment blood pressure (p less than 0.05), and high concentrations of plasma renin and angiotensin II (p less than 0.01). No significant correlation was found between fall in blood pressure and serum sodium concentration, age, renal function, and the dose of captopril given. A severe first dose effect cannot be consistently predicted in individual patients who have received other antihypertensive drugs for severe hypertension. Such patients should have close medical supervision for at least three hours after the first dose of captopril.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Atkinson A. B., Brown J. J., Cumming A. M., Fraser R., Lever A. F., Leckie B. J., Morton J. J., Robertson J. I. Captopril in renovascular hypertension: long-term use in predicting surgical outcome. Br Med J (Clin Res Ed) 1982 Mar 6;284(6317):689–693. doi: 10.1136/bmj.284.6317.689. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Atkinson A. B., Morton J. J., Brown J. J., Davies D. L., Fraser R., Kelly P., Leckie B., Lever A. F., Robertson J. I. Captopril in clinical hypertension. Changes in components of renin-angiotensin system and in body composition in relation to fall in blood pressure with a note on measurement of angiotensin II during converting enzyme inhibition. Br Heart J. 1980 Sep;44(3):290–296. doi: 10.1136/hrt.44.3.290. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. BROWN J. J., DAVIES D. L., LEVER A. F., ROBERTSON J. I. PLASMA RENIN CONCENTRATION IN HUMAN HYPERTENSION. 1. RELATIONSHIP BETWEEN RENIN, SODIUM, AND POTASSIUM. Br Med J. 1965 Jul 17;2(5454):144–148. doi: 10.1136/bmj.2.5454.144. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Brown J. J., Davies D. L., Johnson V. W., Lever A. F., Robertson J. I. Renin relationships in congestive cardiac failure, treated and untreated. Am Heart J. 1970 Sep;80(3):329–342. doi: 10.1016/0002-8703(70)90098-0. [DOI] [PubMed] [Google Scholar]
  5. 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]
  6. Düsterdieck G., McElwee G. Estimation of angiotensin II concentration in human plasma by radioimmunoassay. Some applications to physiological and clinical states. Eur J Clin Invest. 1971 Nov;2(1):32–38. doi: 10.1111/j.1365-2362.1971.tb00565.x. [DOI] [PubMed] [Google Scholar]
  7. Hodsman G. P., Robertson J. I., Semple P. F., Mackay A. Malignant hypertension and oral contraceptives: four cases, with two due to the 30 micrograms oestrogen pill. Eur Heart J. 1982 Jun;3(3):255–259. doi: 10.1093/oxfordjournals.eurheartj.a061301. [DOI] [PubMed] [Google Scholar]
  8. Imai Y., Abe K., Otsuka Y., Sakurai Y., Ito T., Sato M., Haruyama T., Omata K., Hiwatari M., Yoshinaga K. Exaggerated response of renin secretion to captopril (SQ 14225) in renovascular hypertension. Jpn Heart J. 1980 Nov;21(6):793–802. doi: 10.1536/ihj.21.793. [DOI] [PubMed] [Google Scholar]
  9. Laragh J. H., Case D. B., Atlas S. A., Sealey J. E. Captopril compared with other antirenin system agents in hypertensive patients: its triphasic effects on blood pressure and its use to identify and treat the renin factor. Hypertension. 1980 Jul-Aug;2(4):586–593. doi: 10.1161/01.hyp.2.4.586. [DOI] [PubMed] [Google Scholar]
  10. Levine T. B., Franciosa J. A., Vrobel T., Cohn J. N. Hyponatraemia as a marker for high renin heart failure. Br Heart J. 1982 Feb;47(2):161–166. doi: 10.1136/hrt.47.2.161. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. McGrath B. P., Matthews P. G., Johnston C. I. Acute changes in blood pressure and vasoactive hormones after captopril in hypertensive patients. Clin Exp Pharmacol Physiol. 1980 Sep-Oct;7(5):487–491. doi: 10.1111/j.1440-1681.1980.tb00097.x. [DOI] [PubMed] [Google Scholar]
  12. McGrath B. P., Matthews P. G., Johnston C. I. Use of captopril in the diagnosis of renal hypertension. Aust N Z J Med. 1981 Aug;11(4):359–363. doi: 10.1111/j.1445-5994.1981.tb03512.x. [DOI] [PubMed] [Google Scholar]
  13. Millar J. A., Leckie B. J., Morton J. J., Jordan J., Tree M. A microassay for active and total renin concentration in human plasma based on antibody trapping. Clin Chim Acta. 1980 Feb 14;101(1):5–15. doi: 10.1016/0009-8981(80)90050-9. [DOI] [PubMed] [Google Scholar]
  14. Morton J. J., Tree M., Casals-Stenzel J. The effect of captopril on blood pressure and angiotensins I, II and III in sodium-depleted dogs: problems associated with the measurement of angiotensin II after inhibition of converting enzyme. Clin Sci (Lond) 1980 Jun;58(6):445–450. doi: 10.1042/cs0580445. [DOI] [PubMed] [Google Scholar]
  15. Raine A. E., Ledingham J. G. Clinical experience with captopril in the treatment of severe drug-resistant hypertension. Am J Cardiol. 1982 Apr 21;49(6):1475–1479. doi: 10.1016/0002-9149(82)90363-0. [DOI] [PubMed] [Google Scholar]
  16. Tree M., Morton J. J. Evidence that the acute hypotensive effect of captopril in dogs is not wholly explained by a reduction of plasma angiotensin II and its direct vasoconstrictor effect. Clin Sci (Lond) 1980 Dec;59(6):451–456. doi: 10.1042/cs0590451. [DOI] [PubMed] [Google Scholar]
  17. Williams E. D., Boddy K., Harvey I., Haywood J. K. Calibration and evaluation of a system of total body in vivo activation analysis using 14 MeV neutrons. Phys Med Biol. 1978 May;23(3):405–415. doi: 10.1088/0031-9155/23/3/004. [DOI] [PubMed] [Google Scholar]

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