SUMMARY In eight hypertensive patients, forearm vascular tone was assessed by water plethysmography following inhibition of angiotensin H-converting-enzyme (ACE) activity with captopril. Acute captopril administration increased venous distensibility (VVj,,) and decreased forearm vascular resistance (FVR), while it lowered systemic blood pressure (BP). Alpha-one adrenergic receptor blockade by prazosin did not prevent captopril from decreasing vascular tone or lowering blood pressure (BP). Thus, captopril dilated both veins and arterioles. The primary mechanism of captopril's acute antihypertensive action did not involve inhibition of alpha)-adrenergic receptor activity. Moreover, captopril and prazosin together produced a greater reduction in BP and peripheral resistance than occurred with either agent alone. (Hypertension 6: 545-550, 1984) KEY WORDS • angiotensin • prazosin • veins • arterioles • plethysmography • peripheral resistance • sympathetic nervous system • hypertension E LEVATED plasma angiotensin II (ANG II) concentration has been found in patients with severe hypertension 1 -2 and, in some patients, has been correlated with diastolic blood pressure.1 Although the role of ANG II in the pathophysiology of hypertension is not completely understood, inhibition of angiotensin-converting-enzyme activity (ACE) has been reported to lower blood pressure in hypertensive patients.4 " 8 Also, blockade of ANG II formation has been demonstrated to decrease systemic vascular resistance and left ventricular filling pressure in patients with hypertension 9 and in those with severe congestive heart failure.10 "
12The reduction in vascular resistance (afterload) and the decrease in left ventricular filling pressure (preload) imply a decrease in both arteriolar and venous tone. It has been suggested that the reduction in vascular tone following ANG II inhibition may be due to a decrease in sympathetic nervous system activity." The present study presents direct evidence of arteriolar and venous forearm dilation in patients with hypertension treated by inhibition of ACE with captopril. Methods Eight hypertensive patients, five men and three women, aged 38 to 70 years, voluntarily entered this two-part study. During Part 1, or the control period, antihypertensive medications were discontinued for 3 weeks. Patients returned to the University of Virginia Hypertension/Atherosclerosis Unit where plethysmographic studies were performed. A dose of captopril which produced at least a 10 mm Hg decrease in supine diastolic blood pressure (BP) (25 or 50 mg) was then administered, and plethysmography was repeated. During Part 2, patients received prazosin, which was progressively increased from 1 to 5 mg three times daily. One week later patients again underwent plethysmographic study before and after captopril. Thus, plethysmographic determinations were obtained four times in each patient: on no medications, approximately 1 hour after acute captopril administration, after 1 week of prazosin, and again 1 hour after acute captopr...