Circulation, Vol 64, 765-771, Copyright © 1981 by American Heart Association
Acute and chronic treatment of severe and malignant hypertension with the oral angiotensin-converting enzyme inhibitor captopril
DB Case, SA Atlas, PA Sullivan and JH Laragh
The patients with severe and 10 with accelerated or malignant hypertension
were treated with the angiotensin-converting enzyme inhibitor captopril.
Captopril acutely reduced blood pressure in all patients except two who had
suppressed plasma renin activity. Four patients with encephalopathy showed
immediate improvement after the first dose. Two patients could be withdrawn
from nitroprusside infusion upon administration of captopril. Nineteen of
20 patients have remained on captopril for 12-32 months. Blood pressure is
controlled in 18 and improved in two. Eleven required addition of diuretic
and one addition of clonidine. The maximal antihypertensive effect of
captopril with or without diuretics was evident after 3 months of
continuous therapy and was associated with elevated plasma renin levels,
normal aldosterone excretion and preservation of renal function. Captopril
was well- tolerated, but produced occasional rash, loss of taste and
proteinuria. We conclude that captopril, alone or in combination with other
drugs, is effective in both the acute and long-term management of severe
and malignant hypertension.
