Hypertension after renal transplantation. Calcium channel or converting enzyme blockade?
We compared the effects of 4 weeks of calcium channel blockade (amlodipine) or converting enzyme inhibition (lisinopril) on blood pressure and renal hemodynamics in a double-blind crossover trial in a group of 20 hypertensive cyclosporine-treated renal transplant patients. Amlodipine (10 mg) was more effective than the same dose of lisinopril in controlling hypertension (mean 24-hour arterial pressure, 111 +/- 9 and 115 +/- 9 mm Hg, respectively; P < .05). Blood pressure during both treatments was lower than during placebo (124 +/- 12 mm Hg, P < .05). Compared with placebo, amlodipine treatment was associated with a significant increase in glomerular filtration rate (10 +/- 20%, P < .05) and effective renal plasma flow (27 +/- 20%, P < .01) and a decrease in renal vascular resistance (23 +/- 18%, P < .01). Renal hemodynamics did not change during lisinopril. Neither drug had an effect on proteinuria. The data indicate that amlodipine is more effective than lisinopril in controlling hypertension in cyclosporine-treated patients and that treatment with amlodipine but not with lisinopril is accompanied by an increase in glomerular filtration rate and effective renal plasma flow and a decrease in renal vascular resistance. The data suggest that the renin-angiotensin system does not play a main role in determining cyclosporine-associated changes in renal hemodynamics and has a limited role in determining cyclosporine-associated hypertension.
Department of Nephrology, University Hospital Utrecht, The Netherlands.
M R
MR
van der Schaaf
R J
RJ
Hené
M
M
Floor
P J
PJ
Blankestijn
H A
HA
Koomans
D000328:Adult; D017311:Amlodipine / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D018592:Cross-Over Studies; D016572:Cyclosporine / Q000009:adverse effects; D004311:Double-Blind Method; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000209:etiology; D007668:Kidney / Q000187:drug effects; D016030:Kidney Transplantation / Q000009:adverse effects*; D017706:Lisinopril / Q000627:therapeutic use*; D008875:Middle Aged
D017311:Amlodipine; D016572:Cyclosporine; D017706:Lisinopril