Sustained improvement of renal graft function for two years in hypertensive renal transplant recipients treated with nifedipine as compared to lisinopril

Midtvedt, K.; Hartmann, A.; Foss, A.; Fauchald, P.; Nordal, K.P.; Rootwelt, K.; Holdaas, H.

Transplantation 72(11): 1787-1792


ISSN/ISBN: 0041-1337
PMID: 11740389
Accession: 011434364

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Background: Treatment of posttransplant hypertension is still a matter of debate. Calcium antagonists may ameliorate renal side effects of cyclosporin. Angiotensin converting enzyme- (ACE) inhibitors may be more effective in sustaining renal function in native chronic renal disease. We prospectively compared the effect of controlled release nifedipine and lisinopril on long-term renal function in hypertensive kidney transplant patients treated with cyclosporin. Methods: A total of 154 renal transplant patients presenting with hypertension (diastolic blood pressure gtoreq95 mmHg) during the first 3 weeks after transplantation were randomised to receive double-blind nifedipine 30 mg or lisinopril 10 mg once daily. A total of 123 patients completed 1 year of treatment (69 nifedipine, 54 lisinopril) and 64 patients completed 2 years of double-blind treatment (39 nifedipine, 25 lisinopril). Baseline glomerular filtration rate was measured as 99 mTc-diethylene-triaminepentaacetate clearance in a stable phase 2 to 5 weeks after inclusion and repeated at 1 and 2 years. Results: Baseline glomerular filtration rates were similar (46+-16 ml/min with nifedipine, 43+-14 ml/min with lisinopril). The changes in glomerular filtration rates from baseline were statistically significant between the groups after 1 year (9.6 ml/min mean treatment difference (95% confidence interval (CI)s 5.5-13.7 ml/min, P=0.0001) and remained statistically significant also after 2 years (10.3 ml/min mean difference (95% CIs 4.0-16.6), P=0.0017). After 1 year glomerular filtration rates averaged 56+-19 ml/min in the nifedipine group and 44+-14 ml/min in the lisinopril group. Conclusions: Both nifedipine and lisinopril were safe and effective in treatment of hypertension in renal transplant patients treated with cyclosporin. Patients receiving nifedipine but not lisinopril improved kidney transplant function over a period of 2 years.