Combined captopril and spironolactone treatment in Conn's syndrome with renal impairment and refractory hypertension.

Spironolactone alone in full dosage failed to correct hypertension in a patient with Conn's syndrome and renal impairment, although the previously increased total exchangeable sodium fell to normal and the previously suppressed plasma angiotensin II did not rise above the normal range. Addition of the converting enzyme inhibitor captopril reduced plasma angiotensin II to very low levels, with a slight further fall in exchangeable sodium. Blood pressure was well controlled. Because hypertension in Conn's syndrome resistant to spironolactone usually also responds poorly to removal of the adenoma, and is difficult to treat with conventional hypotensive agents, the combination of a converting enzyme inhibitor with a potassium conserving diuretic is worthy of trial in such cases.