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(Hypertension. 1995;25:77-81.)
© 1995 American Heart Association, Inc.

Articles

Hypertension After Renal Transplantation

Calcium Channel or Converting Enzyme Blockade?

Margriet R. van der Schaaf; Ronald J. Hené; Marianne Floor; Peter J. Blankestijn; Hein A. Koomans

From the Department of Nephrology, University Hospital Utrecht, and U-Gene Research (M.F.), Utrecht, the Netherlands.

Correspondence to R.J. Hené, MD, Department of Nephrology and Hypertension (Rm F03.226), University Hospital Utrecht, PO Box 85500, 3508 GA Utrecht, the Netherlands.

Abstract 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.

Key Words: vascular resistance • calcium channel blockers • angiotensin-converting enzyme inhibitors • kidney transplantation • antihypertensive therapy

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