Evaluation of captopril for the management of hypertension in autonomic dysreflexia: a pilot study.

OBJECTIVE: To evaluate the efficacy of captopril for management of hypertensive urgencies in autonomic dysreflexia.

DESIGN: A 1-year, prospective, open-label pilot study.

SETTING: Rehabilitation hospital.

PATIENTS: Twenty-six consecutive patients older than 15 years with spinal cord injury above T6.

INTERVENTIONS: During an autonomic dysreflexia episode, captopril 25mg was administered sublingually if systolic blood pressure (SBP) was at or above 150mmHg despite the use of nondrug measures. If SBP remained elevated 30 minutes after captopril administration, 1 dose of immediate-release nifedipine 5mg was given as rescue by the bite and swallow method and repeated, if necessary, in 15 minutes.

MAIN OUTCOME MEASURE: SBP 30 minutes after captopril administration at initial autonomic dysreflexia episode.

RESULTS: A total of 33 autonomic dysreflexia episodes were documented, of which 18 episodes in 5 patients were treated with drug therapy. Captopril alone was effective in 4 of 5 initial episodes (80%). Mean SBPs at baseline and 30 minutes after captopril were 178+/-18mmHg and 133+/-28mmHg, respectively. There were no cases of reactive hypotension. The addition of nifedipine successfully reduced SBP in the remaining patient. Of the combined 18 initial and repeat autonomic dysreflexia episodes, 94% were successfully treated with our protocol.

CONCLUSION: Captopril appears to be safe and effective for autonomic dysreflexia management.