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A Prospective Evaluation of a Simplified Captopril Test for the Detection of Renovascular Hypertension

Edward D. Frederickson, MD; Christopher S. Wilcox, MD, PhD; C. Michael Bucci; Nicholas R. Loon, MD; John C. Peterson, MD; Nancy L. Brown; Robert D. Thompson; Tanya B. Smith, MD; Charles S. Wingo, MD
Arch Intern Med. 1990;150(3):569-572. doi:10.1001/archinte.1990.00390150065013.
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• Renovascular hypertension is potentially curable but of low prevalence. A previous retrospective study has demonstrated the use of a potentiated increase in plasma renin activity after captopril administration as a diagnostic test for renovascular hypertension; this requires two blood samples for plasma renin activity determination and three inclusive criteria for a positive test result. We applied this test prospectively to screen 100 hypertensive patients for renovascular hypertension. We evaluated 29 patients with renovascular hypertension; the remainder were diagnosed as having essential hypertension. In our patient population, a postcaptopril plasma renin activity of 5.7 ng of angiotensin per milliliter per hour (ngAI·mL1·h−1) or greater had a 100% sensitivity and an 80% specificity for renovascular hypertension. An absolute increase in plasma renin activity with captopril of 4.7 ngAI·mL1·h−1 or greater had a lower sensitivity of 90% and a specificity of 87%, whereas a fractional increase in plasma renin activity after captopril of 150% or higher had the lowest sensitivity of 69% and a specificity of 86%. A subgroup analysis of 38 patients who were receiving diuretic therapy demonstrated that the test sensitivity was unchanged but the specificity was reduced. In conclusion, a single postcaptopril plasma renin activity value of 5.7 ngAI·mL1·h−1 or greater is a simplified screening test for renovascular hypertension, with excellent sensitivity and acceptable specificity. This test is well tolerated, inexpensive, and easy to perform.

(Arch Intern Med. 1990;150:569-572)

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