Renal and haemodynamic effects of amlodipine and nifedipine in hypertensive renal transplant recipients.
BACKGROUND
Immunosuppressive treatment with cyclosporin A (CsA) improves the survival of renal allografts, but is associated with renal vasoconstriction and hypertension. Previous reports suggest that the calcium-channel blockers nifedipine and amlodipine may improve graft function in CsA-treated patients. We have compared the effects of amlodipine (5-10 mg once daily) and nifedipine retard (10-40 mg twice daily) on renal function and blood pressure in renal transplant recipients treated with CsA.


METHODS
This was a multicentre, two-way, crossover study in 27 evaluable hypertensive patients with renal insufficiency following renal transplantation, who were maintained on a stable dose of CsA. Patients received either amlodipine (5-10 mg once daily) or nifedipine retard (10-40 mg twice daily) for 8 weeks, and were then crossed over to the other treatment for a further 8 weeks.


RESULTS
Trends were seen during amlodipine treatment towards larger improvements, in serum creatinine (by 8% of baseline on amlodipine vs 4% on nifedipine), lithium clearance (13% vs 2%), and glomerular filtration rate 11% vs 7%). Effective renal plasma flow was increased by 11% of baseline on nifedipine vs 9% on amlodipine. There were no significant differences between treatments. Amlodipine and nifedipine lowered systolic blood pressure to a similar extent (21 mmHg vs 15 mmHg respectively, P=0.25), but amlodipine was more effective than nifedipine in lowering diastolic blood pressure (13 mmHg vs 8 mmHg, P=0.006). Both treatments were well tolerated.


CONCLUSIONS
Once-daily amlodipine is at least as effective as twice-daily nifedipine retard in controlling blood pressure and does not adversely affect graft function in hypertensive renal allograft recipients.
Venkat-Raman
G
G
St Mary's Hospital, Portsmouth, UK.
Feehally
J
J
Elliott
H L
HL
Griffin
P
P
Moore
R J
RJ
Olubodun
J O
JO
Wilkinson
R
R
D000293:Adolescent; D000328:Adult; D000368:Aged; D017311:Amlodipine / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D002121:Calcium Channel Blockers / Q000627:therapeutic use*; D018592:Cross-Over Studies; D016572:Cyclosporine / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006084:Graft Rejection / Q000503:physiopathology / Q000517:prevention & control; D006801:Humans; D006973:Hypertension / Q000139:chemically induced / Q000188:drug therapy*; D007668:Kidney / Q000187:drug effects* / Q000503:physiopathology; D016030:Kidney Transplantation / Q000502:physiology; D008297:Male; D008875:Middle Aged; D009543:Nifedipine / Q000627:therapeutic use*; D017595:Renal Plasma Flow / Q000187:drug effects*; D016037:Single-Blind Method
D002121:Calcium Channel Blockers; D017311:Amlodipine; D016572:Cyclosporine; D009543:Nifedipine