UNCONTROLLABLE HYPERTENSION IN PATIENTS ON HEMODIALYSIS - LONG-TERM TREATMENT WITH CAPTOPRIL AND SALT SUBTRACTION

  • 1 January 1981
    • journal article
    • research article
    • Vol. 16  (2) , 86-92
Abstract
An inappropriate relationship between renin and exchangeable Na could be responsible for the hypertension of patients with chronic renal failure. Long-term blockade of the renin system by captopril made it possible to test this hypothesis in 8 patients on maintenance hemodialysis. Captopril was administered orally in 2 daily doses of 25-200 mg. Previously, blood pressure averaged 179/105 .+-. 6/3 (mean .+-. SEM [SE of mean]) pre-dialysis and 182/103 .+-. 7/3 mmHg post-dialysis, despite intensive ultrafiltration and conventional antihypertensive therapy. The 4 patients with the highest plasma renin activity normalized their blood pressure with captopril alone, but in the 4 remaining patients, captopril therapy was complemented by salt subtraction which consisted in replacement of 1-2 l of ultrafiltrate by an equal volume of 5% dextrose until blood pressure was controlled. After an average treatment period of 5 mo., blood pressure of all 8 patients was reduced to 134/76 .+-. 7/5 mmHg (P < 0.001) pre-dialysis and 144/81 .+-. 9/5 mm Hg (P < 0.001) post-dialysis without a significant change in body weight. Captopril alone or combined with salt subtraction normalizes blood pressure of patients on chronic hemodialysis with so-called uncontrollable hypertension.