The captopril test for identifying renovascular disease in hypertensive patients

Müller, Franco B.; Sealey, Jean E.; Case, David B.; Atlas, Steven A.; Pickering, Thomas G.; Pecker, Mark S.; Preibisz, J; Laragh, John H.

doi:10.1016/0002-9343(86)90819-3

Cited by 218 publications

(89 citation statements)

References 23 publications

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“…The fall in MABP during renin inhibi tion by CGP 38 560A was less than the fall induced by the single oral administration of 50 mg captopril, a dose which is widely used to investigate the role of the renin angiotensin system in hypertensive patients. 8 This dif ference was not dependent on the level of MABP before the test, 18 since it is also observed in the 7 patients who had a second captopril test, and who at this time had the same initial levels of MABP before converting enzyme inhibition as prior to renin inhibition. This observation contrasts with the results previously obtained in mar mosets.…”

Section: Discussionmentioning

confidence: 73%

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Plasma Angiotensins, Renin, and Blood Pressure During Acute Renin Inhibition by CGP 38 560A in Hypertensive Patients

Jeunemaı̂tre

Ménard

Nussberger

et al. 1989

American Journal of Hypertension

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The new renin inhibitor CGP 38560A has been shown to block angiotensin (ANG) production in healthy volunteers. In order to determine its potential antihypertensive effect, the compound was administered in a 30-min infusion, in 12 hypertensive patients (mean blood pressure ( T he goal of research on renin inhibition is to achieve a more specific blockade of the reninangiotensin system (RAS) than is possible with angiotensin converting enzyme (ACE) inhibi tion. Indeed, renin is an enzyme which acts on a unique substrate, angiotensinogen, whereas converting en zyme splits several substrates, including bradykinin, which may enhance the efficacy of this therapeutic ap proach to hypertension and congestive heart failure, and may also cause some of its side-effects. 1 It is also expected that the clinical use of renin inhibitors will provide a better tool than ACE inhibitors for investigat ing the contribution of the RAS to the regulation of blood pressure and general hemodynamics. The angio tensin II (ANG II) antagonist, saralasin, and the ACE inhibitor, teprotide, were the first pharmacological tools used for this purpose. Depending on the prevailing plasma renin activity (PRA), their hypotensive effects were substantially different. 2 They both lowered blood pressure more when the prevailing PRA was high; over-

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Section: Discussionmentioning

confidence: 73%

“…They had been selected according to the effects on blood pressure of a single oral administration of captopril. 8 This captopril test was performed at 8:00 AM, after 60 min rest in the supine position, 1 to 4 days before the renin-inhibitor infusion. The patients received a single oral dose of 50 mg of captopril.…”

Section: Methodsmentioning

confidence: 99%

Plasma Angiotensins, Renin, and Blood Pressure During Acute Renin Inhibition by CGP 38 560A in Hypertensive Patients

Jeunemaı̂tre

Ménard

Nussberger

et al. 1989

American Journal of Hypertension

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“…Specificity was 89% overall and 86% among blacks. A subset of 69 subjects also had an unstimulated renin measurement, allowing us to apply the "captopril test" criteria established by Muller et al 10 Sensitivity of the captopril test was only 17% overall, without a significant race effect, confirming numerous other investigations suggesting that the criteria for the captopril test do not validate well.…”

Section: Resultsmentioning

confidence: 57%

“…In our patient population, captopril-stimulated renin was not elevated in the majority of blacks with renovascular hypertension. Several investigations of the usefulness of this measurement and of comparisons between stimulated and unstimulated renin have resulted in widely varying test characteristics with sensitivities of the captopril test, 10 for example, ranging from 17% to 100%. n " 13 A subset of our study population also had the captopril test, with no indication that this approach to stimulated renins was superior to a single measurement after captopril stimulation.…”

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confidence: 99%

Similar prevalence of renovascular hypertension in selected blacks and whites.

et al. 1991

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Renovascular hypertension is a potentially curable form of high blood pressure that is thought to be extremely rare among blacks. We demonstrate, however, that in a clinically selected population, the prevalence of renovascular hypertension is similar in blacks and whites. We prospectively evaluated 167 hypertensive subjects who had one or more clinical features known to be associated with renovascular hypertension. All subjects had captopril-stimulated peripheral renin measurements and conventional renal arteriography. All significant renal artery stenoses (greater than 50% luminal narrowing) were treated with percutaneous transluminal angioplasty or surgery. Renovascular hypertension was diagnosed if there was a blood pressure response to interventional therapy, according to the criteria established by the Cooperative Study of Renovascular Hypertension. Of the total group evaluated, 24% (39 of 167) had renal artery stenosis and 14% (23 of 167) had renovascular hypertension. Renal artery stenosis or occlusion was found in 27% (26 of 97) of whites and 19% (13 of 67) of blacks (p=027). Renovascular hypertension was diagnosed in 18% (17 of 97) of whites and 9% (6 of 67) of blacks evaluated (p=0.25). Renovascular hypertension was associated with severe or refractory hypertension and with smoking, but there were no racial differences in these associations. Blacks with renovascular hypertension tended to have low captopril-stimulated peripheral renin activity. We conclude that blacks with clinical features suggestive of renovascular hypertension should be evaluated with angiography. Captopril-stimulated plasma renin may not be useful in detecting blacks with renovascular hypertension, but this and other potential screening tests require further evaluation. (Hypertension 1991;17:678-683) R enovascular hypertension is a potentially curable form of high blood pressure that is thought to be extremely rare among blacks. "3 There is a clear association, however, between renovascular hypertension and extreme elevations in blood pressure. 4-5 The high prevalence of severe hypertension among blacks suggests that this subgroup may have a high prevalence of reversible hypertension. In addition, other clinical features found to be associated with renovascular disease in whites have not been adequately evaluated in blacks. There is no previous report of racial differences in renovascular hypertension in which the diagnosis was made or excluded conclusively based on angiography and response to interventional treatment. We demonstrate that in a clinically selected population, the prevalence of renovascular hypertension is similar in blacks and whites. MethodsAmbulatory hypertensive adults were recruited from the Duke Hypertension Center and the Durham Veterans Affairs Medical Center Hypertension Clinic. Blacks comprise 40% of the combined populations of these two clinics. The diagnosis of hypertension was confirmed if untreated systolic blood pressure was greater than 145 mm Hg or diastolic blood pressure was greater than 90 mm Hg ...

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“…7 Slightly anecdotal is the notion that 'it was occasionally necessary to place the patient in the supine position and to initiate a saline infusion'. 2 It is obvious that the 'true' rate of complications is hard to assess since the published data are not coherent in this regard and certainly far from complete. Also, the captopril doses used are not identical nor are other test variables (Table 1), eg, seated or supine position.…”

Section: Risksmentioning

confidence: 99%

Captopril test: time over?

et al. 1999

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Objective: The role of non-invasive tests for the detection of renovascular hypertension is still a matter of controversy. The 'captopril test' is widely used; its clinical usefulness, however, remains questionable. The aim of the current study was therefore to report our own experience and to review the published data on the diagnostic significance of the test. Patients and methods: Data from 485 hypertensive patients who underwent a captopril test in consecutive order at our institution were analysed retrospectively. After a 30-min resting period in the supine position 50 mg of captopril was given orally. Blood was collected before and 90 min after dosage for the determination of plasma renin concentration (normal range 3.5-8.0 ng/ml/h). An increase by 100% or more of the baseline value was considered a positive response. Blood pressure was recorded at baseline and at 90 min.

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The captopril test for identifying renovascular disease in hypertensive patients

Cited by 218 publications

References 23 publications

Plasma Angiotensins, Renin, and Blood Pressure During Acute Renin Inhibition by CGP 38 560A in Hypertensive Patients

Plasma Angiotensins, Renin, and Blood Pressure During Acute Renin Inhibition by CGP 38 560A in Hypertensive Patients

Similar prevalence of renovascular hypertension in selected blacks and whites.

Captopril test: time over?

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