SHORT TERM RESPONSE AND DONG TERM MANAGEMENT WITH CAPTOPRIL IN SEVERE HYPERTENSION (HT) OF CHILDREN

Abstract

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.