[Long-term treatment with captopril in arterial hypertension complicated by renal failure].

Twenty patients with severe hypertension and chronic renal failure were given Captopril during a one year period. Hypertension was always severe: BP: 193 +/- 11.8 mmHg/120.2 +/- 6.7 mm Hg. Mean glomerular filtration rate (GRF) was 42 +/- 10 ml/mn and renal plasma flow (RPF) was 160 +/- 35 ml/min. Mean plasma renin activity was 1.5 +/- 1.1 ng/ml/h and plasma aldosterone 15.9 +/- 1.9 ng/100 ml. Captopril was given in daily doses from 75 to 300 mg. Furosemide was added in 13 cases, and bêta inhibitions in 10 cases. Blood pressure and renal function were measured eight days, every month end after one year of treatment: the fall in diastolic blood pressure was 13 p. 100 after eight days, 23 p. 100 after one year; a period of at least 6 months was necessary to obtain normal blood pressure values; and after one year blood pressure was normalized (diastolic BP less than 90 mmHg) in 19 patients. Renal function was compared with pretreatment values, after 8 days and one year: --RPF was increased (+18 p. 100 and +10.3 p. 100); --GFR was unchanged (+3,8 p. 100 and -8.8 p. 100); --filtration fraction was significantly decreased: (-12.3 p. 100 and -18.3 p. 100); --sodium excretion rate (+16 p. 100 and +9.9 p. 100) and kaliemia increased (+10 p. 100 and +8 p. 100) but severe hyperkalemia never occurred; --PRA increased (+270 p. 100 and +400 p. 100); --Plasma aldosterone was decreased after eight days --28.9 p. 100 but identical to control after one year -4.4 p. 100. Diuretics were efficient to enhance the antipressor of Captopril, whereas bêta inhibitions appeared less useful, and may be indicated only when tachycardia occurs. These results show that long term use of Captopril alone or associated with Furosemide, can normalise blood pressure in patients with renal insufficiency, without any impairment in GFR, and with an increase in RBF.