The acute blood pressure response to the angiotensin converting enzyme inhibitor, captopril, was used to measure participation of the renin-angiotensin system in treatment-resistant hypertension. By 2 h after a single 25-mg oral captopril dose in patients still receiving a diuretic-vasodilator-beta-blocker combination, systolic and diastolic blood pressures had fallen significantly; the decrease in diastolic pressure correlated with the control (immediately pre-captopril) plasma renin activity (r = 0.64, p < 0.001). Apart from its possible contribution to the underlying hypertension, this captopri-identified renin component may have reflected diuretic and vasodilator-induced renin stimulation that could not adequately be prevented by the renin-lowering properties of the beta-blocker. Captopril, and perhaps other specific antirenin drugs, therefore, may be valuable adjuncts to treatment in patients with hypertension refractory to conventional therapy.