Captopril in Hypertension: Seven Years Later

Summary: Captopril was first administered to hypertensive patients 7 years ago. The relatively high dosage employed and the severity of diseases in the patient population initially led to a high frequency of side effects. Subsequently, an increase in the time intervals for dose titration and the earlier addition of a diuretic have made it possible to reduce the daily dose, thus significantly improving the drug's safety profile without compromising its antihypertensive effect. In a worldwide postmarketing surveillance study of captopril, 6,737 hypertensive patients were enrolled, of whom 3,219 were treated for at least 1 year. Patients had a mean entry blood pressure of 183 (± 31)/111 (± 16) mm Hg while still receiving an average of 2.3 antihypertensive drugs. However, 10.3% were not receiving therapy before entering the study. 1,811 patients (29% of those for whom relevant data were available) had impaired renal function on entry (serum creatinine concentration ≥ 1.6 mg/dl). The hypertension of 881 of the patients (13.1%) was classified as mild to moderate. By design, the types of patients, dosage schedules, and patient monitoring requirements were consistent with the recommendations of the manufacturer at the time the study was initiated. The results of the study showed that long-term antihypertensive efficacy was maintained with a mean captopril dose of approximately 150 mg/day, when used either as monotherapy or more frequently with a diuretic. This dosage was associated with satisfactory control of blood pressure and a considerable reduction in the 12 months' cumulative frequency of drug discontinuation because of adverse reactions (5.8%). Particular note was taken of the beneficial effects of captopril on the kidney. Overall, the safety profile of captopril appears at least as good as that of other commonly used antihypertensive agents.