Long-Term Antihypertensive Therapy with Captopril

SUMMARY Most forms of hypertension require life-long treatment; thus, it is important to deter-mine the continuing effectiveness and safety of any new therapeutic agent. While participating in various investigational studies, 7103 hypertensive patients received captopril, of whom 4397 were treated for 3 months to 4 years. The 4-year patients included 2498 with mild or moderate essential hypertension (diastolic pressure less than 120 mm Hg), 893 with severe essential hypertension, and 517 with renovascular hypertension. Repeated examinations of these long-term therapy patients, the majority of whom also were receiving a diuretic, indicated no drug tolerance to the combination, i.e., there was continuing control of the blood pressure without significant increases in dosage or addition of other drugs. Side-effects occurring during the first few months of captopril administration (rash, taste distur-bances, and, rarely, neutropenia) were not a problem during prolonged therapy. A few patients (70/ 7,103, or 1.0%) developed proteinuria, usually reversible and seldom associated with any deteriora-tion of renal function. The proteinuria occurred most often in patients who had preexisting renal disease and were receiving high doses of the drug. There were no significant changes in key biochemi-cal parameters. A total of 230 patients discontinued treatment for failure to maintain adequate bloo