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In this study, we compared the effects of angiotensin converting enzyme inhibitors, calcium channel Mockers, and diuretics in the same group of renal transplant recipients with hypertension. In addition, it was determined whether a simplified captopril test could predict the response to angiotensin converting enzyme inhibitors.
Thirty patients who were hypertensive while on salt restricted diet were taken into the study. All of them had stable graft function for at least 6 months, without transplant renal artery stenosis and native nephrectomy, and used immunosupressive regimens including cyclosporine.
After a captopril test, enalapril (10 mg/day for 2
weeks), isradipine (5 mg/day for 4 weeks), and
chlortalidone (25 mg/day for 4 weeks) were given to each
patient sequentially. The patients whose blood pressure
did not become normal (mean arterial pressure<I05
mmHg) with monotherapy were treated by the
combination of enalapril and chlortalidone.
Twenty seven patients completed the study. After an oral dose of 50 mg of captopril, a decrease of more than 10 mmHg in diastolic blood pressure occurred in 16 of the 27 patients (positive captopril test). Blood pressure was normalised with enalapril in 43% of patients with positive captopril test while in 27% patients with negative captopril test. The percentage of patients in whom blood pressure became normal was 37, 37, 30 % respectively by enalapril, isradipine, chlorthalidon. In 7 of 11 patients with resistant hypertension to monotherapy, the target mean arterial pressure was reached by the combination of enalapril and chlorthalidon
Diuretics, calcium channel blockers and converting enzyme inhibitors corrected blood pressure only partially in cyclosporine-treated patients with post renal transplantation hypertension. Combination therapy of enalapril and chlorthalidon was necessary in 40% of patients and the combination proved to be safe and effective.