Low-dose captopril: its use in mild to moderate hypertension unresponsive to diuretic treatment

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Abstract
The effect of low doses (25 mg 3 times/day) of captopril was evaluated in 16 patients with mild to moderate essential hypertension, previously uncontrolled by hydrochlorothiazide. After a no-treatment period, mean 8 h seated diastolic blood pressure (SDBP, mm Hg) was 103 .+-. 5 on placebo, 95 .+-. 8 after a single dose of captopril, 96 .+-. 4 after 2 wk of captopril alone and 90 .+-. 6 after its combination with hydrochlorothiazide. Though 9 patients had at least a 10% fall in SDBP after the initial dose of captopril, only 3 had a comparable fall after 2 wk. After captopril and hydrochlorothiazide 12 patients had such a response. Captopril decreased mean angiotensin-converting enzyme activity and plasma aldosterone, though to a lesser extent with continued therapy. Because its side effects appear dose related, low doses of captopril combined with a diuretic are effective and may be better tolerated.