Captopril is an Effective Step-3 Antihypertensive In patients poorly controlled by a ~-blocker and a diuretic

In this multicentre study, 201 patients with poorly controlled essential hypertension (supine diastolic BP ~ 95mm Hg on 13-blocker + diuretic) received the following treatment: chlorthalidone 40mg + oxprenolol 160mg daily (90% of patients) or chlorthalidone 50mg + atenolol 200mg daily for 2 weeks (baseline). If BP was still not controlled, patients were randomised to receive captopril 25 or 50mg bid. After 6 weeks of this treatment, the captopril dose was doubled in non-responders and all patients received a further 4 weeks' of treatment. The 13-blocker was then discontinued in responders, who were followed for a further 4 weeks.

Mean supine BP was reduced (p < 0.01) 2 weeks after captopril was added to the 13-blocker + diuretic regimen in patients on both captopril dosage levels and after 6 weeks, 59.4 and 55.8% of patients on captopril 25 and 50mg bid, respectively, responded. A further 33.3% and 23.9% of patients, responded to captopril 50 and 100mg bid, respectively, after 4 weeks. Mean supine BP rose (p < 0.01/p ~ 0.05) after 13-blocker withdrawal and 22 patients (63%) maintained a supine diastolic BP < 95mm Hg after 4 weeks on captopril + chlorthalidone.

Five percent of patients on captopril 25 and 50mg bid reported adverse effects including itching, rash, ageusia, impotence, dizziness and hypotension. Treatment was withdrawn in 4 patients because of ageusia, impotence, hypotension and skin rash.

Thus, low dose captopril, administered as a step-3 agent, effectively controlled BP in 70% of patients who were poorly controlled on previous standard treatment. MUiesan G. Ailcandri C, Agabitt·Rosei E. Buoninconti R, Cagil V, &tal. Journal of Clinical Hypertension 3: 144·152, Jun 1987

0156-2703/87 !0808-0011 /0$01.00/0 Cl ADIS Press INPHARIIA• 8 August 1987 11