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January 1, 1979Annals of Internal Medicine

Converting Enzyme Inhibition in Hypertensive Emergencies

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Why the study?

Does intravenous teprotide reduce blood pressure and help determine the underlying mechanism to guide therapy in patients with hypertensive emergencies?

Population

18 patients with hypertensive emergencies

Design

Case_series

Follow-up

24 hours

Authors

CTCharles P. TifftBoston University

Discussion

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Implication

May support renin-guided therapy in hypertensive emergencies; hypothesis-generating, requiring randomized confirmation before practice change.

Key Points

  • To assess the diagnostic and therapeutic utility of the angiotensin-converting enzyme inhibitor teprotide in identifying renin-dependent mechanisms and guiding treatment in hypertensive emergencies.
  • Administered intravenous teprotide (SQ 20881, 1 mg/kg) to 18 patients presenting with hypertensive emergencies.
  • Evaluated acute mean blood pressure changes and baseline plasma renin activity to stratify patients into responders, nonresponders, or intermediate responders.
  • Assigned mechanism-specific regimens within 24 hours: propranolol with normal sodium intake (88 meq/day) for responders, diuretics with sodium restriction (10 meq/day) for nonresponders, and combination therapy for intermediate responders.
  • Mean blood pressure decreased by 31 ± 18 mm Hg in 10 responders compared to 5 ± 3 mm Hg in 8 nonresponders following acute SQ 20881 administration.
  • Baseline log plasma renin activity significantly correlated with the reduction in mean blood pressure after SQ 20881 in previously untreated patients (r = 0.651, P < 0.05).
  • Mechanism-directed subsequent therapy lowered overall mean blood pressure from 152 ± 47 mm Hg to 102 ± 31 mm Hg across all patient groups within 24 hours.

Structured PICO

Does intravenous teprotide reduce blood pressure and help determine the underlying mechanism to guide therapy in patients with hypertensive emergencies?

P
Population
18 patients with hypertensive emergencies
I
Intervention
Teprotide (SQ 20881) 1 mg/kg body weight administered intravenously
O
Outcome
Change in mean blood pressuresurrogate

Teprotide acutely lowers blood pressure in a subset of patients with hypertensive emergencies and helps identify renin-dependent hypertension to guide subsequent targeted therapy.

Cite This Study

Charles P. Tifft (1979) studied this question.

synapsesocial.com/papers/6a90da2fea479158cc70f53ehttps://doi.org/10.7326/0003-4819-90-1-43

Topics

Hypertension management
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1An Angiotensin Converting-Enzyme Inhibitor to Identify and Treat Vasoconstrictor and Volume Factors in Hypertensive Patients1974 · 355 citations
  2. 2Effect of Angiotensin Converting Enzyme Inhibition on Blood Pressure, Plasma Renin Activity and Plasma Aldosterone in Essential Hypertension *1978 · 29 citations
  3. 3Use of an Angiotensin II Antagonist (Saralasin) in the Recognition of “Angiotensinogenic” Hypertension1975 · 277 citations
  4. 4Reciprocal Relation between Renin Dependency and Sodium Dependency in Essential Hypertension1976 · 119 citations
  5. 5Case 23-19761976 · 3 citations