This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Hausberg, M. Articles by Rahn, K.-H. Search for Related Content PubMed PubMed Citation Articles by Hausberg, M. Articles by Rahn, K.-H. Related Collections Cardio-renal physiology/pathophysiology Cardiovascular Pharmacology

(Hypertension. 1999;33:862-868.)
© 1999 American Heart Association, Inc.

Scientific Contributions

ACE Inhibitor Versus ß-Blocker for the Treatment of Hypertension in Renal Allograft Recipients

Martin Hausberg; Michael Barenbrock; Helge Hohage; Susanne Müller; Stefan Heidenreich; Karl-Heinz Rahn

From the Department of Internal Medicine D, University of Münster, D-48129 Münster, Germany.

Correspondence to Dr. Martin Hausberg, Medizinische Poliklinik der Westfälischen Wilhelms-Universität Albert-Schweitzer-Straße, 33D-48129 Münster, Germany. E-mail hausber{at}uni-muenster.de

Abstract—Angiotensin-converting enzyme (ACE) inhibitors have been shown to slow the progression of chronic renal failure. However, the value of ACE inhibitors for the treatment of hypertension in renal allograft recipients has not been established. ACE inhibitors dilate the efferent glomerular arteriole, an effect that may aggravate the decrease in glomerular filtration rate resulting from cyclosporine-induced vasoconstriction at the afferent glomerular arteriole. Therefore, the goal of this double-blind, randomized study was to compare the antihypertensive and renal effects of the ACE inhibitor quinapril with those of the ß-blocker atenolol in renal allograft recipients in whom hypertension developed 6 to 12 weeks after transplantation. All patients received cyclosporine as an immunosuppressant and had stable graft function (serum creatinine concentration, <220 µmol/L) at entry into the study. Twenty-nine patients who received quinapril (daily dose titrated between 2.5 and 20 mg) and 30 patients who received atenolol (daily dose titrated between 12.5 and 100 mg) completed the 24-month study. The two groups did not differ in age, sex ratio, height, and weight before entry into the study. Quinapril decreased diastolic blood pressure from 96±1 to 84±1 mm Hg (average throughout treatment period), and atenolol decreased diastolic blood pressure from 96±1 to 83±1 mm Hg. The serum creatinine concentration did not change significantly in either group after 24 months (129±8 µmol/L at entry and 148±19 µmol/L after 24 months in the quinapril group and 131±6 µmol/L at entry and 152±15 µmol/L after 24 months in the atenolol group; P=NS for both groups). After 24 months, the change in urinary albumin excretion from baseline was -10±15 mg/d in the quinapril group and 52±32 mg/d in the atenolol group (P=0.03). These results show that quinapril and atenolol are effective antihypertensive drugs when used after renal transplantation. Moreover, compared with atenolol, quinapril has no adverse effects on graft function. The relative reduction in albuminuria observed with quinapril as compared with atenolol could indicate a beneficial effect of quinapril on long-term graft function.

Key Words: transplantation, renal • hypertension • adrenergic receptor blockers • angiotensin-converting enzyme inhibitors • cyclosporine

This article has been cited by other articles:

				A. M. Jevnikar and R. B. Mannon Late Kidney Allograft Loss: What We Know about It, and What We Can Do about It Clin. J. Am. Soc. Nephrol., March 1, 2008; 3(Supplement_2): S56 - S67. [Abstract] [Full Text] [PDF]

				D. L Jennings and D. J Taber Use of Renin-Angiotensin-Aldosterone System Inhibitors Within the First Eight to Twelve Weeks After Renal Transplantation Ann. Pharmacother., January 1, 2008; 42(1): 116 - 120. [Abstract] [Full Text] [PDF]

				G. Heinze, C. Mitterbauer, H. Regele, R. Kramar, W. C. Winkelmayer, G. C. Curhan, and R. Oberbauer Angiotensin-Converting Enzyme Inhibitor or Angiotensin II Type 1 Receptor Antagonist Therapy Is Associated with Prolonged Patient and Graft Survival after Renal Transplantation J. Am. Soc. Nephrol., March 1, 2006; 17(3): 889 - 899. [Abstract] [Full Text] [PDF]

				J. Lindenfeld, R. L. Page II, R. Zolty, S. F. Shakar, M. Levi, B. Lowes, E. E. Wolfel, and G. G. Miller Drug Therapy in the Heart Transplant Recipient: Part III: Common Medical Problems Circulation, January 4, 2005; 111(1): 113 - 117. [Full Text] [PDF]

				J. S. Zaltzman, M. Nash, R. Chiu, and R. Prasad The benefits of renin-angiotensin blockade in renal transplant recipients with biopsy-proven allograft nephropathy Nephrol. Dial. Transplant., April 1, 2004; 19(4): 940 - 944. [Abstract] [Full Text] [PDF]

				H. Reichel, M. Zeier, and E. Ritz Proteinuria after renal transplantation: pathogenesis and management Nephrol. Dial. Transplant., February 1, 2004; 19(2): 301 - 305. [Full Text] [PDF]