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Keywords:

Adult, Angiotensin-Converting Enzyme Inhibitors, Blood Pressure, Captopril, Female, Humans, Hypertension, Renal, Hypertension, Renovascular, Male, Middle Aged, Nephrectomy, Prognosis, Proline, Science & Technology, Life Sciences & Biomedicine, Cardiac & Cardiovascular Systems, Cardiovascular System & Cardiology, 1102 Cardiorespiratory Medicine and Haematology, Cardiovascular System & Hematology, 3201 Cardiovascular medicine and haematology

Abstract:

Converting-enzyme inhibition as a guide to the hypotensive response to be expected from surgery was evaluated in 27 hypertensive patients with renovascular disease. Blood pressure averaged 163 +/- 5/102 +/- 2 mm Hg (mean +/- standard error of the mean) during converting-enzyme inhibition with captopril, 518 +/- 29 mg daily for 2.8 +/- 0.3 months, and stabilized at a similar level of 165 +/- 4/104 +/- 3 mm Hg during 5.0 +/- 0.6 months of postoperative follow-up, when no medication was administered. Postoperative pressure, both systolic (r = +0.53; p = 0.004) and diastolic (r = +0.55; p = 0.003), was correlated with blood pressure during converting-enzyme inhibition. In addition, multiple regression analysis identified systolic pressure during converting-enzyme inhibition as the only significant (p less than 0.01) predictor of postoperative systolic pressure. Diastolic pressure during converting-enzyme inhibition (p less than 0.05) in conjunction with circulating renin (p less than 0.05) and renin suppression from the contralateral kidney (p less than 0.01) explained up to 53% of the postoperative diastolic pressure. Therefore, blood pressure during long-term converting-enzyme inhibition may be useful as a predictor of the postoperative blood pressure in hypertensive patients with renovascular disease.