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Autonomic Dysreflexia

Captopril

Captopril is a specific competitive inhibitor of angiotensin I-converting enzyme (ACE). During an episode of AD, 25mg of captopril is recommended for sublingual administration.

Author Year; Country
Score
Research Design
Sample Size
Methods Outcome

Esmail et al. 2002; Canada
Pre-post
N=7

Population: 26 consecutive patients older than 15 years with SCI above T6.
Treatment: administration of a) captopril 25mg sublingually if systolic blood pressure (SBP) was at or above 150mmHg, b) 5mg of immediate-release nifedipine if SBP remained elevated 30 minutes after captopril administration.
Outcome Measures: SBP
  1. A total of 33 autonomic dysreflexia episodes were documented in 7 patients.
  2. The 18 episodes documented in 5 patients were treated with drug therapy.
  3. Captopril alone was effective in reducing SBP in 4 of 5 the patients (80%). The mean SBPs at baseline and 30 minutes after captopril were 178(18) mmHg and 133(28)mmHg, respectively.
  4. The addition of nifedipine successfully reduced blood pressure from 170/108 to 110/80 after 30 minutes in the one patient who did not respond to the administration of captopril.

Discussion

From one pre-post study (n=26) (Esmail et al. 2002), captopril was safe and effective in 4 out of 5 episodes for AD management. This prospective open labelled study and numerous experts’ opinion suggest the use of the captopril as a primary medication in management of AD (Consortium for Spinal Cord Medicine 2001Frost 2002Anton & Townson 2004).

Conclusion

There is level 4 evidence (from one pre-post study: Esmail et al. 2002) for the use of captopril in the acute management of AD in SCI.

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