Why the study?
Does a single-dose captopril test accurately detect renovascular hypertension in patients with high-renin hypertension?
Does a single-dose captopril test accurately detect renovascular hypertension in patients with high-renin hypertension?
Captopril-stimulated peripheral plasma renin activity is an effective screening tool for detecting renovascular hypertension, offering superior discriminating power compared to other standard modalities.
Captopril test may aid renovascular hypertension screening in high-renin patients; leaves open need for prospective validation before practice change.
To examine the utility of the single-dose captopril test in detecting renovascular hypertension (RVHT), the authors measured peripheral plasma renin activity (PRA), before and thirty and sixty minutes after an oral dose of captopril (25 mg), in 28 patients with RVHT and 22 patients with high-renin essential hypertension (EHT) without renal artery stenosis who were consuming 8 grams of sodium chloride per day. There was considerable overlap of individual values in basal PRA between the two groups. Sixty minutes after captopril, PRA was higher in RVHT than in EHT patients (74.8 +/- 63.9 versus 15.1 +/- 11.9 ng/mL/hr, P < 0.01). With the cutoff point set at 16 ng/mL/hr, RVHT was detected with a sensitivity of 96% and a specificity of 77%. The discriminating power was also superior to that based on blood pressure response to angiotensin II analogue under sodium depletion, rapid-sequence intravenous pyelography, or renography. These results show that captopril-stimulated peripheral PRA is an adequate screening tool for detecting RVHT in a population with high-renin hypertension.
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Takata et al. (1994) studied this question.
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