Long-term converting-enzyme inhibition as a guide to surgical curability of hypertension associated with renovascular disease.
Converting-enzyme inhibition as a guide to the hypotensive response to be expected from surgery was evaluated in 27 hypertensive patients with renovascular disease. Blood pressure averaged 163 +/- 5/102 +/- 2 mm Hg (mean +/- standard error of the mean) during converting-enzyme inhibition with captopril, 518 +/- 29 mg daily for 2.8 +/- 0.3 months, and stabilized at a similar level of 165 +/- 4/104 +/- 3 mm Hg during 5.0 +/- 0.6 months of postoperative follow-up, when no medication was administered. Postoperative pressure, both systolic (r = +0.53; p = 0.004) and diastolic (r = +0.55; p = 0.003), was correlated with blood pressure during converting-enzyme inhibition. In addition, multiple regression analysis identified systolic pressure during converting-enzyme inhibition as the only significant (p less than 0.01) predictor of postoperative systolic pressure. Diastolic pressure during converting-enzyme inhibition (p less than 0.05) in conjunction with circulating renin (p less than 0.05) and renin suppression from the contralateral kidney (p less than 0.01) explained up to 53% of the postoperative diastolic pressure. Therefore, blood pressure during long-term converting-enzyme inhibition may be useful as a predictor of the postoperative blood pressure in hypertensive patients with renovascular disease.
D000328:Adult; D000806:Angiotensin-Converting Enzyme Inhibitors; D001794:Blood Pressure / Q000187:drug effects; D002216:Captopril / Q000494:pharmacology*; D005260:Female; D006801:Humans; D006977:Hypertension, Renal / Q000601:surgery*; D006978:Hypertension, Renovascular / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D011379:Prognosis; D011392:Proline / Q000031:analogs & derivatives*
D000806:Angiotensin-Converting Enzyme Inhibitors; D011392:Proline; D002216:Captopril