Schreij G, van Es P N, Schiffers P M, Lavrijssen A T, de Leeuw P W
Department of Internal Medicine, University Hospital, Maastricht, The Netherlands.
J Hum Hypertens. 1995 Sep;9(9):741-6.
In forty six hypertensive patients in whom a high level of clinical suspicion for renovascular hypertension was present on the basis of clinical clues, a captopril test was performed with either 25 mg of captopril or placebo on 2 separate days to determine prospectively the value of the captopril test. Blood pressure (BP) and peripheral renin were used as response variables. All patients had discontinued their anti-hypertensive medication and were not salt depleted. In all patients selective renal angiography was performed irrespective of the results of the captopril test. Twenty patients proved to have uni- or bilateral renal artery stenosis (RAS) giving a prevalence of 43%. After the placebo and after captopril there were no significant changes (absolute or proportional) in BP values between patients with essential hypertension or RAS, either for all measurements or if only the fall in BP was taken into account. The receiver operator characteristic curves of both baseline and post-captopril peripheral renin levels indicate that the captopril test does not discriminate appropriately between patients with essential hypertension and RAS. Therefore, we would not advise the use of the captopril test as a screening test for RAS in hypertensive patients in whom a high level of clinical suspicion for RAS is already present.
在46例根据临床线索高度怀疑患有肾血管性高血压的高血压患者中，在2个不同日期分别给予25 mg卡托普利或安慰剂进行卡托普利试验，以前瞻性地确定卡托普利试验的价值。将血压（BP）和外周肾素作为反应变量。所有患者均已停用抗高血压药物，且未出现盐耗竭。无论卡托普利试验结果如何，所有患者均进行了选择性肾血管造影。20例患者被证实存在单侧或双侧肾动脉狭窄（RAS），患病率为43%。在服用安慰剂和卡托普利后，原发性高血压患者或RAS患者的血压值（绝对值或比例）均无显著变化，无论是所有测量值还是仅考虑血压下降情况。基线和卡托普利治疗后外周肾素水平的受试者工作特征曲线表明，卡托普利试验不能恰当地区分原发性高血压患者和RAS患者。因此，对于已经高度怀疑患有RAS的高血压患者，我们不建议使用卡托普利试验作为RAS的筛查试验。
