Comparison of Perindopril and Amlodipine in Cyclosporine-Treated Renal Allograft Recipients

Abstract

The objective of this study was to compare the antihypertensive efficacy and influence on renal function of perindopril and amlodipine in cyclosporine-treated renal allograft recipients with mild to moderate hypertension. We conducted a randomized, double-blind, double-dummy crossover trial in ambulatory patients. Four phases were conducted: 2 weeks on placebo, 8 weeks of maintenance (perindopril or amlodipine), and 2 weeks of washout between treatment periods. Ten hypertensive patients with stable renal allograft function transplanted more than 6 months previously and receiving cyclosporine as part of their immunosuppressive regimen were studied. The patients were allocated to perindopril (2 or 4 mg/d) and amlodipine (5 mg/d) in a random sequence. If office diastolic pressure was greater than or equal to 90 mm Hg after 4 weeks, the dosage was doubled and continued for another 4 weeks. The main outcome measures were office and 24-hour ambulatory blood pressure changes after 8 weeks of active treatment and treatment and time effect on glomerular filtration rate and effective renal plasma flow. Perindopril and amlodipine were equally effective in lowering office blood pressure and similarly efficacious for the 24-hour period of the day. Neither drug affected glomerular filtration rate or effective renal plasma flow. Both agents demonstrated equivalent capacity (time x treatment, P = .955) to reverse renal vascular resistance (amlodipine from 0.35 +/- 0.02 to 0.30 +/- 0.02 mm Hg/mL per minute per 1.73 m2; perindopril from 0.36 +/- 0.03 to 0.32 +/- 0.01) (time effect of all treatments together, P = .043).(ABSTRACT TRUNCATED AT 250 WORDS)

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

“…We also showed a reduction of proteinuria with the ACE inhibitor quinapril; however, we did not observe significantly better allograft function in quinapril-treated as compared with atenolol-treated renal transplant patients receiving cyclosporine. Recently, several investigators [32][33][34][35][36][37][38] assessed the effects of ACE inhibitors in renal allograft recipients receiving cyclosporine. However, study groups were small compared with groups in this study, and, with one exception, 32 all these studies had relatively short observation periods of 3 months or less.…”

“…However, study groups were small compared with groups in this study, and, with one exception, 32 all these studies had relatively short observation periods of 3 months or less. Mourad et al, 32 van der Schaaf et al, 33 Sennesael et al, 34 Curtis et al, 35 and Abu-Romeh et al 36 compared the effects of an ACE inhibitor with those of a calcium antagonist. None of these studies showed adverse effects of the ACE inhibitors.…”

The use of cyclosporine in dermatology: Part II

“…There have been reports of angiotensin-converting enzyme inhibitors causing a decrease in GFR in cyclosporine-treated hypertensive patients, although other studies have shown perindopril to be equally effective as amlodipine in lowering blood pressure without affecting GFR or effective renal plasma flow. [100][101][102] The use of thiazide diuretics may lead to increased nephrotoxicity. 103 Potassium-sparing diuretics should also be avoided, because cyclosporine can increase serum potassium.…”

Calcium Channel Blockade and Preservation of Renal Graft Function in Cyclosporine-Treated Recipients: A Prospective Randomized Placebo-Controlled 2-Year Study

“…Sustained renal ischemia and direct vascular endothelial and renal tubular cell toxicity leads to arteriolar hyalinization, tubular atrophy, interstitial fibrosis (TGF-␤1), and glomerulosclerosis (17). Several clinical trials have investigated the possible protective role that calcium channel blockers (18 -20) and other antihypertensive drug types, such as angiotensinconverting enzyme (ACE) inhibitors (21,22), can exert on renal graft function and arterial hypertension in CNI-treated recipients. However, the results of these studies are conflicting and leave some questions unanswered.…”