Captopril challenge test

A diagnostic test for primary aldosteronism

Captopril Challenge Test

The Captopril Challenge Test is a diagnostic procedure used primarily to evaluate patients for primary aldosteronism, a condition characterized by excessive production of aldosterone by the adrenal glands. This test helps differentiate primary aldosteronism from other causes of hypertension.

Chemical structure of Captopril

Background

Primary aldosteronism, also known as Conn's syndrome, is a common cause of secondary hypertension. It results from the overproduction of aldosterone, which leads to sodium retention, potassium excretion, and increased blood pressure. The Captopril Challenge Test is used to assess the renin-angiotensin-aldosterone system (RAAS) and its response to captopril, an angiotensin-converting enzyme inhibitor.

Procedure

The test involves administering a single oral dose of captopril, typically 25 to 50 mg, to the patient. Blood samples are taken before and after the administration of captopril to measure plasma renin activity (PRA) and plasma aldosterone concentration (PAC).

Pre-Test Preparation

• Patients are usually advised to maintain a normal sodium diet for at least one week prior to the test.
• Certain medications, such as diuretics, beta-blockers, and nonsteroidal anti-inflammatory drugs, may need to be discontinued before the test.

Test Administration

1. A baseline blood sample is collected to measure PRA and PAC. 2. Captopril is administered orally. 3. Blood samples are collected at intervals, typically 1 to 2 hours after captopril administration, to measure the changes in PRA and PAC.

Interpretation

In patients with primary aldosteronism, the administration of captopril does not significantly increase PRA or decrease PAC, due to the autonomous secretion of aldosterone. In contrast, patients with secondary causes of hypertension, such as renovascular hypertension, typically show a significant increase in PRA and a decrease in PAC after captopril administration.

Advantages and Limitations

The Captopril Challenge Test is a non-invasive and relatively simple test to perform. However, it may not be definitive in all cases, and further confirmatory tests, such as adrenal vein sampling, may be required for accurate diagnosis.

Related Pages

• Primary aldosteronism
• Hypertension
• Renin-angiotensin-aldosterone system
• Captopril