ISSN:
1432-1440
Keywords:
Hypertension
;
Captopril
;
Renin
;
Screening
;
Renovascular hypertension
;
Bilateral renal artery stenosis
Source:
Springer Online Journal Archives 1860-2000
Topics:
Medicine
Notes:
Summary The place of captopril (C) testing in the screening for renovascular hypertension is still controversial. Baseline and C-stimulated plasma renin concentrations (PRC) were measured in 113 hypertensives, who where referred for the exclusion of secondary hypertension. In addition intravenous digital subtraction angiography (DSA) and a renal scintigraphy were performed. When renal artery disease was revealed by DSA or renin was stimulated the renal arteries were visualized by direct arteriography (and treated by angioplasty if possible). 86 patients underwent each diagnostic test: 21% had renovascular hypertension. Unilateral renal artery stenosis (n=10) was detected by the captopril test (cutoff values: baseline〉40 µU/ml, after C〉180 µU/ml, sensitivity 100%). Bilateral renal artery stenosis (n=8) was missed when the disease was equally severe on either side (sensitivity 50%). The specificity of C testing was 82%, overall sensitivity (uni- and bilateral disease 78%, prevalence 21%, predictive value of the positive test 0.56, predictive value of the negative test 0.93). With i.v.-DSA the renal arteries were technically evaluable in 91% (82/92) of cases. The sensitivity for the detection of all renal artery stenoses was 79% (unilateral 100%, bilateral 40%, specificity 97%). The sensitivity of renal scintigraphy for the detection of unilateral renal artery stenosis was 50%, for the detection of bilateral renal artery stenoses 43%, specificity 81%. The present study demonstrates the usefulness of captopril for the detection of unilateral renal artery stenosis. Since bilateral renal artery disease is frequent and frequently missed by the test, overall and split renal function should be evaluated in addition. Both tests can easily be combined at one time when a captopril scintigraphy with renin determination is performed.
Type of Medium:
Electronic Resource
URL:
http://dx.doi.org/10.1007/BF01741782
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