Captopril in the treatment of scleroderma renal crisis.

Scleroderma is a disease of unknown cause characterized by interstitial fibrosis and vascular lesions in many organ systems. Renal failure, often associated with malignant hypertension, may ensue as a life-threatening component of this disorder. Activation of the renin-angiotensin-aldosterone system has been hypothesized as a cause of this complication. Captopril has been used in 23 patients with this condition. Of this group, 20 (87%) responded favorably with a decrease of the supine diastolic BP to less than 90 mm Hg and a reduction in the serum creatinine level in 14 patients. During long-term therapy (median, 29 months), 11 of the 23 patients continued to have a good clinical response while receiving captopril. Six patients died and six patients were alive after captopril therapy was discontinued. These data suggest that captopril is beneficial in the treatment of scleroderma renal crisis.

Twenty-four hour blood pressure monitoring in the evaluation of once daily treatment of essential hypertension with captopril.

A new ambulatory blood pressure monitoring system is being used in a study of once daily treatment of essential hypertension with captopril. The Instruments for Cardiac Research system consists of a small, battery powered monitoring device carried by the patient and a base unit containing a microcomputer. On completion of the 24-hour monitoring schedule, the base unit extracts the data from the portable unit. The base unit can then display the data in tabular or graphic form on its printer, or record it on a built in microcassette recorder. The data can readily be transferred to a main frame computer for subsequent analysis. Ninety-eight percent of the patients wore the unit initially with only an additional 2% refusals at 3 subsequent evaluations during the 5 month trial. Eighty-six percent of the tapes had one-half or more of the readings.

Long-term therapy for chronic bacteriuria in men. U.S. Public Health Service cooperative study.

Response to therapy, renal function, and mortality were analyzed in a prospective study of 249 men with bacteriuria followed for up to 10 years. All patients received initial organism-specific antibiotic therapy followed by 2 years of continuous treatment with sulfamethizole, nitrofurantoin, methenamine mandelate, or placebo. Continuous therapy with active drugs delayed recurrence of bacteriuria and reduced acute clinical exacerbations of infection. Patients with pure Escherichia coli bacteriuria, normal intravenous pyelogram, no previous therapy, and a normal prostate had a good prognosis with short-term antibiotic therapy alone. The presence of prostatic or upper urinary tract calculi, pyelonephritic scars, or mixed or enterococcal infections predicted a poor bacteriologic prognosis. In the absence of severe urologic disease or concomitant noninfectious renal disease no patients with persistent bacteriuria developed renal failure. Continuous antibiotic therapy is of value in selected male patients with bacteriuria in reducing recurrence and acute clinical exacerbations of urinary tract infection.