439 ACUTE AND CHRONIC USE OF THE ANGIOTENSIN I CONVERTING ENZYME INHIBITOR (CAPTOPRIL) IN CHILDHOOD HYPERTENSION
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Three patients, aged 10-18 yrs, with uncontrolled hypertension, have been treated with the angiotensin I converting enzyme inhibitor (captopril) for 15-29 mos. Their diagnoses are malignant
hypertension of unknown etiology, Takayasu's arteritis with renal involvement and single kidney hydronephrosis and renal artery stenosis. Two patients had four test doses of oral captopril
in doses of 12.5-50 mg. The changes in Mean Arterial Pressure (MAP) and Plasma Renin Activity (PRA) at 90′ were:
Serum aldosterone decreased by 90′ in all tests by an average of 81.2%, range 78.1-91.2%. The MAP in two patients on captopril alone, 150-250 mg/day, decreased by 6.4 and 18.8%. The third,
with Takayasu's arteritis, is taking prazosin in addition to 400 mg of captopril. His MAP has decreased by 9.6% but he remains severely hypertensive. In all three PRA has remained elevated
and serum and urinary aldosterone levels have remained suppressed. Retinal and cardiac hypertensive changes have improved. We conclude captopril can be a useful therapeutic modality in the
treatment of uncontrolled childhood hypertension.
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