Effects of Converting Enzyme Inhibition on Split Renal Function in Renovascular Hypertension

• Published in: Hypertension (Dallas, Tex. 1979) Vol. 8; no. 5; pp. 415 - 421
• Main Authors: MIYAMORI, ISAMU, YASUHARA, SHUICHIRO, TAKEDA, YOSHIYU, KOSHIDA, HIDEO, IKEDA, MASATOSHI, NAGAI, KUNIO, OKAMOTO, HARUYA, MORISE, TOSHIO, TAKEDA, RYOYU, ABURANO, TAMIO
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA American Heart Association, Inc 01.05.1986; Hagerstown, MD Lippincott
• Subjects: Adult; Aldosterone - blood; Angiotensin-Converting Enzyme Inhibitors; Arterial hypertension. Arterial hypotension; Biological and medical sciences; Blood and lymphatic vessels; Captopril - therapeutic use; Cardiology. Vascular system; Clinical manifestations. Epidemiology. Investigative techniques. Etiology; Glomerular Filtration Rate - drug effects; Humans; Hypertension, Renal - complications; Hypertension, Renal - drug therapy; Hypertension, Renal - enzymology; Kidney - blood supply; Kidney - drug effects; Medical sciences; Middle Aged; p-Aminohippuric Acid - metabolism; Pentetic Acid - metabolism; Regional Blood Flow - drug effects; Renal Artery Obstruction - complications; Renin - blood; Technetium - metabolism; Technetium Tc 99m Pentetate; Hypertension; Enzyme inhibitor; Cardiovascular disease; Renal function; Angiotensin converting enzyme; Renal artery disease
• ISSN: 0194-911X; 1524-4563
• DOI: 10.1161/01.HYP.8.5.415

The effects of captopril on effective renal plasma flow and glomerular filtration rate were studied using a noninvasive radioisotopic method on individual kidneys in eight patients with renovascular hypertension and 12 patients with essential hypertension with various renin levels. Four patients with renovascular hypertension had unilateral while three had bilateral renal artery stenosis. The effective renal plasma flow and glomerular filtration rate were determined by using I-iodohippurate sodium and “Tc-diethylenetriamine pentaacetic acid, respectively. Glomerular filtration rate and effective renal plasma flow were significantly reduced in the stenotic kidneys of patients with renovascular hypertension compared with values in nonstenotic kidneys (p < 0.01). Treatment with captopril, 37.5 to 75 mg/day for 1 to 48 weeks, further reduced the glomerular filtration rate only in stenotic kidneys, and effective renal plasma flow increased in both kidney types. In two of the three renal hypertensive patients with bilateral renal artery stenosis, captopril produced a reversible azotemia that was unrelated to the fall in blood pressure, as evidenced by the lack of azotemia seen after a moderate blood pressure reduction induced by other antihypertensive medications. These results indicate that endogenous angiotensin II is essential in maintaining the glomerular filtration rate in stenotic kidneys and suggest that a reduction in glomerular filtration rate during captopril administration could indicate the presence of renal artery stenosis.