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

Postma, Cornelis T.; Steen, Pieter H. M. van der; Hoefnagels, Willibrod H. L.; Boo, Theo de; Thien, Theo

doi:10.1001/archinte.1990.00390150111021

Cited by 48 publications

(10 citation statements)

References 22 publications

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“…This group of investigators discontinued sodium restriction as well as all antihypertensive medication for 2 weeks. Postma and associates 36 were also unable to confirm the value of each of the biochemical criteria recommended by Muller and associates. 3 Our approach to the evaluation of a diagnostic test for renal artery stenosis was to use well-described clinical criteria to select an enriched population in which the pretest probability of disease is high and therefore in which a diagnostic test is most useful.…”

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confidence: 90%

“…All medications, including diuretics, were withheld for 7 days, and not all patients termed essential hypertensives had angiograms to prove that renal artery stenosis was not present. In a better-designed study, Postma and associates 36 performed the captopril test in 149 unselected patients and found it far too insensitive (39%) to be useful. This group of investigators discontinued sodium restriction as well as all antihypertensive medication for 2 weeks.…”

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confidence: 99%

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Simplified captopril renography in diagnosis and treatment of renal artery stenosis.

et al. 1991

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To improve the diagnosis and forecast the response to surgery or renal angioplasty in patients with hypertension and renal artery stenosis, we employed a simplified captopril renography protocol in conjunction with renal arteriography in 94 clinically selected patients. Fifty hypertensive patients (group 1) with a high clinical likelihood of renovascular hypertension were evaluated using a simplified captopril renography protocol and renal angiography on the arterial side. Criteria for normal captopril renal scintigrams were established based on this original cohort and validated in an additional 44 clinically comparable patients (group 2). Renal revascularization or nephrectomy was performed in 39 patients, and success of the procedure was determined in the 34 patients for whom 3-month follow-up was available. In the 94 patients, 44 (47%) had renal artery stenosis. Simplified captopril renography was 91% sensitive and 94% specific in identifying or excluding renal artery stenosis in the combined group, with no difference in the diagnostic utility between groups 1 and 2, or in those with renal insufficiency (n=38) or those with bilateral disease (n=17). Scintigraphic abnormalities induced by captopril were strongly associated with cure or improvement in blood pressure control following revascularization or nephrectomy (15 of 18), while the lack of captoprilinduced changes was associated with failure of such intervention (13 of 16) (/?=0.0004). We conclude that simplified captopril renography is highly sensitive and specific in the diagnosis of renal artery stenosis in a clinically selected high-risk population and that the test accurately predicts the success or failure of therapeutic intervention. {Hypertension 1991; 18:289-298)

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Simplified captopril renography in diagnosis and treatment of renal artery stenosis.

et al. 1991

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“…Because renovascular hypertension can be treated successfully in a large number of patients, it is worthwhile to try to identify those with this condition among the general hypertensive population [22][23][24][25]. However, the certain diagnosis of a renal artery stenosis can only be made by an-giography [22][23][24][25].…”

Section: Discussionmentioning

confidence: 99%

“…However, the certain diagnosis of a renal artery stenosis can only be made by an-giography [22][23][24][25]. In view of the low prevalence of renal artery stenosis in the hypertensive population, angiography, because of its invasive nature and cost, cannot be used as a screening procedure.…”

Section: Discussionmentioning

confidence: 99%

Urinary prostaglandin and prostaglandin metabolite excretion in patients with essential hypertension or hypertension with renal artery stenosis

Postma

Boo²,

Thomas

et al. 1995

The Netherlands Journal of Medicine

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Background: Recent studies have reported elevated prostaglandin levels in patients with renal artery stenosis and hypertension. To investigate whether a distinction between essential hypertension and hypertension with renal artery stenosis is possible by measuring eicosanoid excretion, we studied the excretion of these compounds in patients with essential hypertension and in hypertensives with concomitant renal artery stenosis.Methods: The 24-h urinary excretion of metabolites of prostaglandin I2, prostaglandin E 2 and metabolites of thromboxane A 2 was sampled under standardised conditions, in 15 patients with essential hypertension and in 15 patients with unilateral renal artery stenosis with hypertension. Also clinical and biochemical characteristics of the subjects were analysed.Results: The patients with renal artery stenosis had significantly lower excretion of prostaglandin I 2 than did the essential hypertensive patients. However, the overlap in the values was large, thus not allowing a diagnostic differentiation according to urinary prostaglandin I z levels. The excretion of prostaglandin E 2 and of metabolites of thromboxane A 2 showed no significant differences among the groups.Conclusions: Measurement of urinary prostaglandin or prostaglandin metabolite excretion did not contribute to the non-invasive detection of the presence of a renal artery stenosis in the patients in this study.

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“…Some authors require an angiographic stenosis of at least 70 to 75% to make the diagnosis, 6-8 whereas others use a cut-off of 50% narrowing. 9 Functional data, however, are usually not provided in most published series on any diagnostic procedure for the disease. With some limitations the most widely accepted functional criterion is cure or improvement (reduced number of antihypertensive medications) of hypertension after revascularisation, information that rarely is provided.…”

Section: Renovascular Hypertension Vs Renal Artery Stenosismentioning

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 in the Detection of Renovascular Disease in Hypertensive Patients

Cited by 48 publications

References 22 publications

Simplified captopril renography in diagnosis and treatment of renal artery stenosis.

Simplified captopril renography in diagnosis and treatment of renal artery stenosis.

Urinary prostaglandin and prostaglandin metabolite excretion in patients with essential hypertension or hypertension with renal artery stenosis

Captopril test: time over?

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