Efficacy of an oral angiotensin-converting enzyme inhibitor (captopril) in severe hypertension

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Abstract
The antihypertensive effect of captopril was assessed during short- and long-term periods in 10 patients with elevated blood pressure readings that were uncontrollable by standard therapy (supine diastolic blood pressure of > 100 mm Hg, with a regimen of propranolol hydrochloride, hydralazine hydrochloride, hydrochlorothiazide). When given alone captopril therapy was unable to normalize blood pressure in any patient. The addition of hydrochlorothiazide to the captopril therapy normalized blood pressure in 1 patient and sharply improved blood pressure in 4 others. Blood pressure in the remaining patients responded inadequately to this combination. The addition of propranolol to captopril and hydrochlorothiazide reduced the blood pressure further in most cases (7 of the 10 patients had normal blood pressure readings while they received these 3 drugs). In 4 patients, blood pressure response to the added propranolol was unrelated to changes in plasma angiotensin II concentration. Captopril was helpful in the management of refractory hypertension in most cases.