Comparison of the effects of enalapril and losartan on posttransplantation erythrocytosis in renal transplant recipients: prospective randomized study.
BACKGROUND
The aim of this prospective randomized study was to compare the safety and efficacy of enalapril (E) and losartan (L) in the treatment of posttransplantation erythrocytosis and the effect of the ACE genotype on response to therapy.


METHODS
Twenty-seven (24 male and 3 female, mean age 34+/-8 years) renal transplant recipients with erythrocytosis were treated either with E (15 patients) (10 mg/day) or L (12 patients) (50 mg/day) for 8 weeks.


RESULTS
The hemoglobin levels were significantly decreased in the L (17.1+/-0.7 to 15.9+/-1.3 g/dl, P=0.01) and E groups (17.4+/-1.1 to 14.9+/-2.2 g/dl, P=0.001). Among the responders who discontinued treatment, there was a trend for longer time to relapse in the L group (7.38+/-3.75 months; 95% confidence interval: 0.03-14.7) compared with the E group (2.75+/-0.70 (95% confidence interval: 1.37-4.13) (P=0.11). Decrease in hemoglobin was more prominent with E compared with L (-3.26+/-0.65 vs. -1.70+/-0.39 g/dl, P=0.05). Decrease in hemoglobin levels between DD and non-DD genotype groups was similar (-2.0+/-1.5 vs. -1.7+/-2.3 g/dl, P=0.69).


CONCLUSIONS
Enalapril caused a greater decrease but faster relapse in hemoglobin levels compared with losartan in patients with posttransplantation erythrocytosis. The DD type polymorphism had no effect on response.
Yildiz
A
A
Department of Internal Medicine, Nephrology BD 34390, Istanbul School of Medicine, Topkapi, Istanbul, Turkey. alaattiny@hotmail.com
Cine
N
N
Akkaya
V
V
Sahin
S
S
Ismailoğlu
V
V
Türk
S
S
Bozfakioğlu
S
S
Sever
M S
MS
D000328:Adult; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D004656:Enalapril / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D005838:Genotype; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D019808:Losartan / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D007703:Peptidyl-Dipeptidase A / Q000235:genetics; D011086:Polycythemia / Q000097:blood / Q000188:drug therapy*; D011446:Prospective Studies
D000806:Angiotensin-Converting Enzyme Inhibitors; D006454:Hemoglobins; D004656:Enalapril; D007703:Peptidyl-Dipeptidase A; D019808:Losartan