Short term response to single dose of Captopril has been studied in 15 severe HT children at least 24 h after cessation of anti HT drugs. Blood pressure (BP) fell significantly (p < 0,001) PRA rose (p < 0,01) plasma aldosterone fell (p < 0,02) in the 6 first hours. Sequential measurement of plasma converting enzyme activity (PCEA) in 6 cases shows significant inhibition. Decrease in PCEA does not constantly parallel the decrease of BP suggesting intervention of other (s) mechanism (s). A positive poor correlation was found between fall of BP and increase of PRA (r = 0,45), a negative one was found between fall of BP and inuline distribution volume (r = 0,52). Long term treatment with Captopril (7days to 12 months, average 101 days) has been performed in 10 patients with resistant HT. 4 of them had a chronic renal failure (mean inulin clearance 25 ml/mn/1.73 sq.m) and 3 were haemodialysed. Maximal dosage was 200 mg/1.73 sq/m/day ; low salt diet was maintained. BP was normalized in 9 cases. In the last patient partially uncontrolled BP and dialysis hypotensions led to bilateral nephrectomy. In one patient with graft artery stenosis Captopril induced a dramatic fall of BP and a consecutive acute reversible tubulopathy leading to cessation of the drug. 5 patients are still treated ; GFR improved in 2 cases. No “allergic” side effect has been observed. Since this side effect is dose related it is fully recommended to obtain the lowest dosage by associating salt depletion.
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