G. Venkatraman et al., RENAL AND HEMODYNAMIC-EFFECTS OF AMLODIPINE AND NIFEDIPINE IN HYPERTENSIVE RENAL-TRANSPLANT RECIPIENTS, Nephrology, dialysis, transplantation, 13(10), 1998, pp. 2612-2616
Background. Immunosuppressive treatment with cyclosporin A (CsA) impro
ves the survival of renal allografts, but is associated with renal vas
oconstriction and hypertension. Previous reports suggest that the calc
ium-channel blockers nifedipine and amlodipine may improve graft funct
ion in CsA-treated patients. We have compared the effects of amlodipin
e (5-10 mg once daily) and nifedipine retard (10-40 mg twice daily) on
renal function and blood pressure in renal transplant recipients trea
ted with CsA. Methods. This was a multicentre, two-way, crossover stud
y in 27 evaluable hypertensive patients with renal insufficiency follo
wing renal transplantation, who were maintained on a stable dose of Cs
A. Patients received either amlodipine (5-10 mg once daily) or nifedip
ine retard (10-40 mg twice daily) for 8 weeks, and were then crossed o
ver to the other treatment for a further 8 weeks. Results. Trends were
seen during amlodipine treatment towards larger improvements, in seru
m creatinine (by 8% of baseline on amlodipine vs 4% on nifedipine), li
thium clearance (13% vs 2%), and glomerular filtration rate 11% vs 7%)
. Effective renal plasma flow was increased by 11% of baseline on nife
dipine vs 9% on amlodipine. There were no significant differences betw
een treatments. Amlodipine and nifedipine lowered systolic blood press
ure to a similar extent (21 mmHg vs 15 mmHg respectively, P=0.25), but
amlodipine was more effective than nifedipine in lowering diastolic b
lood pressure (13 mmHg vs 8 mmHg, P=0.006). Both treatments were well
tolerated. Conclusion. Once-daily amlodipine is at least as effective
as twice-daily nifedipine retard in controlling blood pressure and doe
s not adversely affect graft function in hypertensive renal allograft
recipients.