Humoral and hemodynamic effects of increasing doses of captopril in patients with essential hypertension

Sassano, P; Pedrinelli, Roberto; Magagna, Armando; Abdel-Haq, B.; Salvetti, Antonio

doi:10.1016/0002-9149(82)90395-2

Cited by 9 publications

(6 citation statements)

References 6 publications

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“…In a recent study in which the captopril test was found to have a 100% specificity and sensitivity, both 25 and 50 mg of captopril were used, illustrating that above 25 mg, the dose-response curve of captopril becomes flat. 12,21,22 A possible explanation for the discrepancy between our test results and those of others may be found in the length of time patients have had hypertension caused by RAS. In these patients, the hypertension can be separated into three phases.23"25 In the first phase, relief of the stenosis will lead to normalization ofthe blood pressure.…”

Section: Ras(n = 24)contrasting

confidence: 76%

“…More important, the test results in the patients undergoing treatment of their stenosis show that a negative test result also does not exclude an improvement in blood pressure readings after treatment of the stenosis. 22 (1) 0.14 (0.5) Plasma renin activity in essential hypertension (EH) and renal artery stenosis (RAS) and hypertension before and after an oral dose of 25 mg of captopril. Horizontal bars indicate mean values of the groups.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

The Captopril Test in the Detection of Renovascular Disease in Hypertensive Patients

Postma

Steen²,

Hoefnagels³

et al. 1990

Arch Intern Med

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Section: Ras(n = 24)contrasting

confidence: 76%

Section: Resultsmentioning

confidence: 99%

The Captopril Test in the Detection of Renovascular Disease in Hypertensive Patients

Postma

Steen²,

Hoefnagels³

et al. 1990

Arch Intern Med

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“…The mechanism(s) by which captopril, when given acutely, reduced blood pressure seems to be mainly the inhibition of angiotensin II generation [8,10,II] and this hypothesis is in agreement with our finding that the acute hypotensive effect of the drug was directly related to basal renin values [11,16] and that its administration significantly increased PRA and reduced aldosterone [10,11,16],…”

Section: Discussionsupporting

confidence: 90%

“…The reasons for the discrepancy between these and our results is not readily explained, since both studies were performed on inpatient on similar sodium intake and using a similar dose of captopril. Moreover, it is expected that the amount of a single dose used did not influence the entity of blood pressure response, since the absolute hypotensive effect of captopril is independent of dose [16], The only possible explanation is that in the former study [8] at least 3 out of 10 patients were under treatment up to 12 h before the introduction of captopril.…”

Section: Discussionmentioning

confidence: 93%

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

Salvetti

Arzilli

Nuccorini

et al. 1986

Nephron

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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.

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“…Several studies testing the vasodilating effect of shortterm administration of ACE-inhibitors demonstrated a vasodilating effect only in the presence of a sodiumdepletion condition in healthy subjects [12,13], suggesting a vasodilating activity of this class of drugs in the presence of a stimulated circulating RAS. However, this finding, which could indicate a greater antihypertensive effect of ACE-inhibitors in patients with high renin levels, is in contrast with experimental and clinical data demonstrating that the hypotensive effect of ACEinhibitors is often independent from their action on the circulating RAS [14][15][16][17]. At the present time, no conclusive data are available in hypertensive patients concerning the relationship between the vasodilating effect of intrabrachial infusion of ACE inhibitors and the circulating and vascular RAS profile.…”

Section: Introductionmentioning

confidence: 82%

Relationship between the Circulating and Vascular Renin-Angiotensin System and the Vasodilating Effect of Captopril in Human Hypertension

Virdis

Ghiadoni²,

Favilla³

et al. 1999

Blood Pressure

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Virdis A, Ghiadoni L, Favilla S, Duranti P, Taddei S, Salvetti A. Relationship between the circulating and vascular renin-angiotensin system and the vasodilating effect of captopril in human hypertension. Blood Pressure 1999; 8: 85-93.A vascular renin-angiotensin system (RAS) is present in the forearm vasculature of essential hypertensive patients and is closely related to the circulating renin profile. To test whether the haemodynamic effect of acute intrabrachial administration of captopril is related to the circulating and/or vascular RAS, 31 hypertensive patients were selected and divided into four groups according to their different circulating RAS profile (n = 7 hypertensive patients with primary aldosteronism and suppressed plasma renin activity; n = 7 low renin essential hypertensive patients; n = 8 normal renin essential hypertensive patients; n = 9 high renin renovascular hypertensive patients). The forearm net balance of active renin, plasma renin activity and angiotensin II, obtained by intrabrachial infusion of the b-adrenergic receptor agonist isoproterenol (0.03, 0.1, 0.3 mg/100 ml/min) and calculated as the product of the venous-arterial plasma concentration gradient and forearm blood flow (FBF), was closely related to the circulating RAS. Captopril (0.25, 2.5, 25 mg/100 ml/min per 20 min each dose) unchanged basal FBF in the primary aldosteronism and low renin groups (FBF increase: from 3.9 AE 0.4 to a maximum of 4.1 AE 0.5 and from 3.8 AE 0.3 to a maximum of 4.3 AE 0.5 ml/100 ml/min, respectively), whereas it caused slight vasodilation in the normal renin group (from 3.9 AE 0.3 to a maximum of 5.3 AE 0.7 ml/100 ml/min), and pronounced vasodilation in the high renin group (from 4.0 AE 0.4 to a maximum of 6.4 AE 0.5 ml/100 ml/min). Captopril-induced vasodilation showed a significant direct correlation with the circulating and vascular RAS. The present data, while confirming the existence of a vascular RAS in the forearm of hypertensive patients indicate that the acute vasodilating effect of intrabrachial captopril is linked to a stimulated RAS, either circulating or vascular, supporting the evidence that, in acute conditions, ACE inhibitors exert their vasodilating effect through the RAS blockade.

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Humoral and hemodynamic effects of increasing doses of captopril in patients with essential hypertension

Cited by 9 publications

References 6 publications

The Captopril Test in the Detection of Renovascular Disease in Hypertensive Patients

The Captopril Test in the Detection of Renovascular Disease in Hypertensive Patients

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

Relationship between the Circulating and Vascular Renin-Angiotensin System and the Vasodilating Effect of Captopril in Human Hypertension

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