A new examination method for detecting renovascular hypertension: functional DTPA renal scintigraphy sensitized by captopril.

DTPA functional renal camera scintigraphy (DTPA-FS) was performed in 220 patients with moderately severe and severe hypertension after an initial 7-14-day Captopril + thiazide-type diuretic treatment. If, comparing it with the DTPA-FS prior to treatment, appearance or increase of a side difference were observed and it was also indicated by the clinical picture, nephroangiography was performed. Using this method, 15 cases of unilateral, 3 bilateral renal arterial stenoses were recognized, and in one case restenosis was diagnosed, in all cases of positive DTPA-FS with Captopril. In negative case of DTPA-FS sensitized with Captopril, there was no positive angiographic finding. The method of DTPA-FS performed under Captopril effect is considered to be a simple, harmless, specific out-patient examination for screening genuine renovascular hypertension. To perform several angiographies likely to be negative can be avoided by this method. The hypotensive effect of Captopril may, at the same time, be a useful guide in differentiating patients with renovascular hypertension being suitable most of all for surgical intervention or angioplasty.

Combined captopril treatment in severe and moderately severe hypertension resistant to therapy.

Combined Captopril treatment was applied in 61 patients with severe or moderately severe hypertension in patients insufficiently or not reacting to the usual combined antihypertensive therapy (3-7 kinds of drug). The combination included diuretics, beta-blockers, alpha-blockers, vasodilators, Ca-antagonists and centrally acting agents. Diuretics were used in all cases. Average duration of treatment was 8.2 months (i.e. 2-40 months). Mean systolic pressure prior to Captopril treatment was 202.4 mm Hg (S.D. +/- 27.6), while the diastolic 122.0 mm Hg (S.D. +/- 11.3). During combined Captopril treatment the average values were 154.2 mm Hg (S.D. +/- 18.8) and 97.6 mm Hg diastolic pressures (S.D. +/- 10.7), the difference being significant (p less than 0.001). Refractory hypertension occurred in three middle-aged female patients in response to combined Captopril treatments. Captopril treatment had to be discontinued for the appearance of side-effects (severe skin symptoms) only in a single case. A minor deterioration of renal functions was observed in three patients (in one bilateral renovascular, and in two essential hypertension). Serum creatinine value and renal functions of four patients showed significant improvement as a result of combined Captopril treatment. During combined Captopril treatments (also with a diuretic) two patients had so severe hypokalaemia that they needed potassium substitution or administration of a potassium-saving diuretic.