Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0085580 (essential hypertension)
 14,686 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Chronic responses of systemic hemodynamics and blood pressure counterregulatory ("pseudo-tolerance") mechanisms were investigated in matched groups of patients with essential hypertension after 1 month of vasodilator therapy with pinacidil (a direct arterial dilator), prazosin (an alpha 1-adrenergic blocking drug) or captopril (an angiotensin-converting enzyme inhibitor). For equivalent decreases in mean arterial pressure compared with placebo baseline (approximately 8 mm Hg supine and 12 mm Hg upright), prazosin and captopril did not increase cardiac index or heart rate. In contrast, marked decreases in systemic vascular resistance with pinacidil (approximately 25%, p less than 0.05) were accompanied by reflex increases in cardiac index (approximately 20%, p less than 0.05). Activity of the sympathetic nervous system, measured by supine and upright plasma norepinephrine (NE), increased approximately 50% with pinacidil and prazosin (p less than 0.001 each), whereas captopril decreased supine plasma NE by 12% (p less than 0.05) and did not change upright plasma NE. All 3 drugs caused an expansion of height-adjusted blood volume (approximately 14%). Pinacidil and prazosin caused reversible weight gains of 0.9 and 0.7 kg, respectively, whereas captopril reversibly decreased body weight by 0.8 kg (p less than 0.05), suggesting differential effects of the 3 drugs on interstitial fluid volume. During chronic therapy, all 3 drugs may require concomitant diuretic therapy, whereas concomitant sympatholytic therapy may be required with the potent vasodilator pinacidil. Captopril may be associated with the lowest cardiac risk because of its lack of stimulatory effects on the sympathetic nervous system and cardiac index.
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PMID:Chronic effects of direct vasodilation (pinacidil), alpha-adrenergic blockade (prazosin) and angiotensin-converting enzyme inhibition (captopril) in systemic hypertension. 288 2

The effect of adding either nifedipine or captopril as third-line agents was studied in a single-blind crossover fashion in 24 patients with essential hypertension uncontrolled by combination beta blocker and diuretic therapy. Nineteen patients completed both phases of the study. The mean initial sitting blood pressure before the addition of nifedipine was 164/109 mm Hg and captopril 165/108 mm Hg. Both nifedipine and captopril produced further significant reductions in both sitting and standing blood pressure, 47% of the captopril-treated patients achieving target blood pressure of less than 160/95 mm Hg compared with 67% with nifedipine. Further increase in the dosage resulted in 63% of the captopril- and 81% of the nifedipine-treated patients achieving target blood pressure. There were, however, no statistically significant differences in the mean fall in blood pressure or in the number of patients obtaining target pressure at the end of each treatment period. Captopril treatment also resulted in a small reduction of pulse rate, and, although pulse rates rose with nifedipine, these changes were not significant. Both treatments were generally well tolerated, and serious side effects were not reported. Both nifedipine and captopril were effective and well tolerated as third-line antihypertensive agents.
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PMID:Comparison of nifedipine and captopril as third-line agents in hypertensive patients uncontrolled with beta-blocker and diuretic therapy. 289 31

We measured plasma renin activity and plasma catecholamines in 26 untreated patients with phaeochromocytoma, 18 untreated patients with primary hypertension, and 10 normal control volunteers. Plasma renin activity measured in patients in the supine position, standing position and after walking for 1 h was higher in the subjects with phaeochromocytoma than in those with primary hypertension or in the volunteers (F = 9, P less than 0.001). In all three situations, renin activity was closely correlated with noradrenaline levels in the phaeochromocytoma patients (r = 0.545, r = 0.600, and r = 0.739; P less than 0.01) but not in the subjects with primary hypertension or in the volunteers. The cardioselective beta-blocker acebutolol reduced heart rate, mean blood pressure and renin activity by averages of 20, 12 and 89% respectively in the seven phaeochromocytoma patients given the drug. Captopril decreased mean blood pressure by 19% and raised renin activity by 293% in the nine phaeochromocytoma patients tested. These findings show that in phaeochromocytoma, hypertension is accompanied by high renin levels and that renin release is stimulated in response to noradrenaline overflow. The hypotension observed in response to beta-blockade and captopril provides indirect support for the possibility that renin-dependent mechanisms are involved in the hypertension of phaeochromocytoma.
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PMID:Plasma renin activity in phaeochromocytoma: effects of beta-blockade and converting enzyme inhibition. 290 35

The haemodynamic pattern of the common carotid artery was studied in men with sustained essential hypertension using pulsed Doppler methods before and after administration of vasodilating drugs. Captopril produced both a fall in vascular resistance and an increase in arterial diameter of the common carotid artery. Isosorbide dinitrate increased markedly the arterial diameter but did not change vascular resistance. Nitrendipine decreased vascular resistance with no change in the arterial diameter. In the common carotid circulation of patients with essential hypertension, vasodilating drugs may either dilate small arteries (nitrendipine), large arteries (isosorbide dinitrate), or both (captopril).
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PMID:Haemodynamic effects of vasodilating drugs on the common carotid and brachial circulations of patients with essential hypertension. 293 36

To compare the antihypertensive and humoral effects of the angiotensin-converting enzyme inhibitors captopril and enalapril, 20 patients with essential hypertension, not receiving treatment for 2 weeks and consuming a prescribed sodium ion intake, were randomly assigned to two parallel, double-blind treatment groups with stratification based on race and untreated seated diastolic blood pressure. These groups received a placebo (day -1) followed by either captopril, 200 mg every 12 hours (n = 9), or enalapril maleate, 20 mg every 12 hours (n = 11), alone (days 1 to 14) and then with hydrochlorothiazide, 25 mg every 12 hours (days 16 to 28). Captopril and enalapril were coadministered alone (day 15) and with hydrochlorothiazide (day 29) to assess whether further decreases in blood pressure would occur. Captopril and enalapril alone caused comparable decreases (p less than 0.05) in the mean 12 hour time-averaged seated diastolic blood pressure from values on day -1 (placebo), on day 1 (11 and 9 mm Hg, respectively) and day 14 (8 and 7 mm Hg, respectively). The addition of hydrochlorothiazide further decreased (p less than 0.05) blood pressure in each group (7 and 8 mm Hg, respectively) from values on day 14. Combined use of captopril and enalapril did not result in further reduction. Coupled with the comparable changes observed in each treatment group in serum angiotensin-converting enzyme activity, plasma renin activity and plasma aldosterone concentration, these data support the view that captopril and enalapril have similar antihypertensive effects and mechanisms.
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PMID:Double-blind comparison of captopril and enalapril in mild to moderate hypertension. 300 84

Arterial hypertension shows, in the elderly, particular features and special problems connected with its pharmacological treatment. In our work ten patients, aged between 65-75, suffering from essential hypertension, were examined for eight weeks. At the end of this period, we observed a significant reduction of systolic and diastolic pressure, heart rate being unchanged. We didn't observe any significant change in the metabolic parameters considered (uricemia, creatininemia, triglycerides and cholesterol). No patient had to interrupt the treatment as a consequence of side effects. According to our data, we can affirm that Captopril reduces arterial pressure gradually and doesn't cause orthostatic hypotension, being thus very useful in the elderly.
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PMID:[Hypertension therapy in the elderly. Our experience with converting enzyme inhibitors]. 302 20

Captopril effects were studied in 27 patients with second-stage essential hypertension following administration of a single 25 mg oral dose of the drug. Blood pressure (BP), blood angiotensin-1-converting enzyme (ACE) activity, active (APR) and inactive (IPR) plasma renin levels were measured every 30 minutes for 3 hours. Before and near the end of the acute test, urinary kallikrein and catecholamine excretions were measured, and systemic and regional hemodynamic changes assessed. BP decreased in 21 patients: 11 of those had low basal APR (group 1), and 10 had normal or moderately elevated APR (group 2). The greatest hypotensive effect was observed within 1.5 hours after the administration, coinciding with the most marked ACE inhibition. There was no significant intergroup difference with respect to the extent of the hypotensive effect. No correlation was found between the hypotensive effect and the degree of ACE inhibition. All patients showed significantly decreased arteriolar tone, increased venous distensibility, decreased total peripheral resistance, and expanded end diastolic volume, while their cardiac output and heart rate remained unaffected. Hypertensive patients with low APR gave no evidence of renin-angiotensin inhibition or kallikrein-kinin activation that might have accounted for the hemodynamic effect of captopril.
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PMID:[Mechanisms of the hypotensive action of captopril in essential hypertension]. 303 55

Captopril Research Group of Japan made an evaluation of clinical usefulness of captopril in the treatment of mild to moderate essential hypertension. A relatively low frequency of side effects manifested as clinical symptoms was observed when the daily dose of captopril used was 37.5-112.5 mg. Antihypertensive effect was well maintained in this dose range. Follow-up surveillance of captopril also confirmed this. Abnormalities in blood chemistry were also found to be very less frequent. Untoward metabolic effects of ACE inhibitors such as alteration of serum electrolytes, lipid profiles or glucose metabolism were reported to be minimal or not actually observed. Side effects and untoward metabolic effects may appear more frequently when the same dose was given in patients with renal impairment. ACE inhibitors can be used as the first choice of drugs in the treatment of essential hypertension with no renal function impairment.
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PMID:Side effects and metabolic effects of converting enzyme inhibitors. 303 27

Twenty-four black men with mild to moderate essential hypertension were enrolled in an open-label trial comparing the efficacy of two doses of Capozide (captopril and hydrochlorothiazide). All antihypertensive drugs were discontinued and patients then received placebo for 2 weeks. Twenty-two patients, mean age 59.1 +/- 14.3 years, with sitting diastolic blood pressure (BP) 92 to 110 mm Hg, entered the 6-week active-drug phase. Eleven patients (Group A) were randomized to Capozide 25/15 and 11 (Group B) to Capozide 50/15. Baseline mean BPs were 151.0/100.7 mm Hg in Group A and 153.1/100.7 mm Hg in Group B. At week 6, mean BPs were 128.7/84.4 mm Hg in Group A and 126.8/82.7 mm Hg in Group B. Uric acid, blood urea nitrogen and creatinine levels rose slightly in both groups. There were no adverse events. Eighteen patients had normal BPs at study completion. Twice-daily Capozide treatment is effective and well tolerated in blacks; patients responded equally well to both doses.
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PMID:Treating black hypertensives with capozide. 304 29

Captopril is an orally active inhibitor of angiotensin-converting enzyme (ACE) and has been widely studied in the treatment of patients with mild to moderate essential hypertension, severe hypertension not responsive to conventional diuretic/beta-adrenoceptor blocker/vasodilator regimens, and patients with chronic congestive heart failure refractory to treatment with a diuretic and digitalis. In patients with mild or moderate essential hypertension, titrated low doses of captopril used alone or in conjunction with a diuretic are similar in efficacy to usual doses of hydrochlorothiazide, chlorthalidone, or beta-adrenoceptor blocking drugs, as well as to the other ACE inhibitors. In addition, captopril improved well-being to a greater extent than methyldopa or propranolol in a study designed specifically to determine the effect of treatment on the quality of life of patients with mild or moderate essential hypertension. The earlier demonstrated efficacy of captopril, used with a diuretic and often also with a beta-adrenoceptor blocking drug, in the treatment of severe hypertension refractory to conventional 'triple therapy' has been confirmed in more recent trials which illustrate the generally marked antihypertensive effect of captopril-containing regimens in such patients. Results of initial trials in patients with scleroderma are promising, with control of hypertension and stabilization of renal function in these patients when treated at an early stage of the disease. Several comparative and long term trials of captopril in patients with chronic congestive heart failure refractory to treatment with a diuretic/digitalis regimen clearly demonstrate that initial haemodynamic improvement is maintained and correlates with clinical benefit. A tendency for overall clinical response to captopril to be better than the response to prazosin, hydralazine, nisoldipine or enalapril has been reported. Results of a multicentre comparison with digoxin and placebo indicate that captopril is a suitable alternative to digoxin in patients with mild to moderate heart failure who are receiving maintenance diuretic therapy. The tolerability of captopril has now been studied in many thousands of patients involved in formalized trials and the early impression of poor tolerability can no longer be justified. The use of generally lower dosages of captopril in patients with normal or slightly impaired renal function has resulted in a generally low incidence of rash (0.5 to 4%), dysgeusia (0.1 to 3%), proteinuria (0.5%), neutropenia (0.3% during first 3 months) and symptomatic hypotension (0.1 to 3%). Cough is an infrequent but troublesome effect resulting from ACE inhibition.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Captopril. An update of its pharmacodynamic and pharmacokinetic properties, and therapeutic use in hypertension and congestive heart failure. 306 99


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