Acute Response to Captopril as a Predictive Test for Surgery in Renovascular Hypertension

Abstract

To test the hypothesis that acute angiotensin-converting enzyme (ACE) inhibition might predict the postoperative blood pressure outcome, a single oral dose of captopril ranging from 12.5 to 100 mg, was given to 26 patients with renovascular disease and its hypotensive effect was compared with that of surgery (21 patients) or of percutaneous transluminal angioplasty (PTA) (5 patients). Both systolic and diastolic blood pressure fell significantly (p < 0.001) from 179.9 ± 5.4/114.1 ± 2.1 to 148.4 ± 3.8/94.1 ± 1.9 after captopril and to 141.1 ± 3.7/88.9 ± 2.0 at least 3 months after operation. Postoperative pressure values were directly related to those after captopril (SBP: r = 0.65, p < 0.001; DBP: r = 0.45, p < 0.05) as were their absolute decrements (SBP:r = 0.70, p < 0.001 ;DBP:r = 0.64, p < 0.001). However, after captopril, individual pressure tended to be higher (and their decrements to be lower) than after operation. 12 out of 19 patients cured by surgery were considered cured by captopril, while 5 out of the remaining 7 were improved and 2 not cured. The 6 patients improved by surgery or PTA were also improved by captopril and the only patient not cured by surgery was not cured by captopril. Therefore, if we consider both cure and improvement as a positive result, the captopril test gave 23 true-positive, 1 true-negative and 2 false-negative responses. Taken together, these data suggest that acute ACE inhibition may be an useful tool in predicting postoperative blood pressure of patients with renovascular disease.

Captopril-Stimulated Renin Secretion in the Diagnosis of Renovascular Hypertension

“…Reasons for excluding studies included: (1) review articles and letters -44%, (2) peripheral renin measurements not obtained pre-and post-captopril -36%, (3) not a single dose study-16%, and captopril not used -4%. In addition to these 19 studies, [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] two articles meeting inclusion criteria were identified from references of review articles 29,30 and one from a textbook reference. 31 No additional articles were identified by experts or the manufacturer.…”