Efficacy of low-dose captopril in addition to furosemide and spironolactone in patients with decompensated liver disease during blunted diuresis

J Hepatol. 1992 May;15(1-2):40-7. doi: 10.1016/0168-8278(92)90009-e.


The renin-angiotensin-aldosterone system is activated by diuretics and involved in the diuretic resistance of cirrhotic patients with ascites and oedema. In previous studies relatively high doses of captopril (25-400 mg daily) were unsuccessful in promoting diuresis and natriuresis in these patients. We analyzed the efficacy of a low dose of captopril in eight patients with massive ascites resistant to therapy of salt/fluid restriction and increasing doses of spironolactone and furosemide. Mean duration of diuretic use was 73 days (range 7-240 days). After at least 3 days of observation on 80 mg furosemide and 100 mg spironolactone only, captopril was added. Four out of eight patients responded with an increase in natriuresis and diuresis; daily dose of captopril was 20.6 mg in responders and 26.5 mg in non-responders. After the addition of captopril the mean weight change was -7.5 kg in responders and +0.25 kg in non-responders. Mean urinary sodium output in responders increased from 72.8 (S.D. = 35.2) to 128.5 (63.5) mmol within 10 days. Increased diuresis in responders made diuretic reduction necessary: mean furosemide from 80 to 53.3 mg, and mean spironolactone from 100 to 68.1 mg. Creatinine clearances remained stable. High levels of plasma renin activity, plasma aldosterone and angiotensin-II were found in all patients. Non-responders showed more severe hyponatremia and higher vasopressin levels. Natriuretic atrial factor (NAF) was in the upper-normal range or slightly elevated in both groups. In non-responders we noticed low levels of cGMP in 24-h urine, compared with responders.(ABSTRACT TRUNCATED AT 250 WORDS)

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aldosterone / blood
  • Angiotensin II / blood
  • Atrial Natriuretic Factor / blood
  • Captopril / adverse effects
  • Captopril / standards*
  • Creatinine / blood
  • Cyclic GMP / urine
  • Diuresis / drug effects
  • Diuresis / physiology*
  • Dose-Response Relationship, Drug
  • Drug Therapy, Combination
  • Female
  • Follow-Up Studies
  • Furosemide / adverse effects
  • Furosemide / standards*
  • Humans
  • Kidney / drug effects
  • Kidney / physiology
  • Liver / drug effects
  • Liver / physiology
  • Liver Cirrhosis / blood
  • Liver Cirrhosis / drug therapy*
  • Liver Cirrhosis / epidemiology
  • Male
  • Middle Aged
  • Renal Dialysis
  • Renin / blood
  • Sodium / urine
  • Spironolactone / adverse effects
  • Spironolactone / standards*


  • Angiotensin II
  • Spironolactone
  • Aldosterone
  • Furosemide
  • Atrial Natriuretic Factor
  • Captopril
  • Sodium
  • Creatinine
  • Renin
  • Cyclic GMP