Regression of left ventricular hypertrophy by AT(1) receptor blockade in renal transplant recipients

AT(1) receptor antagonists control blood pressure (BP) effectively and redu ce left ventricular hypertrophy in patients with essential hypertension. Be cause left ventricular hypertrophy is very common in renal transplant recip ients, we examined the cardiovascular effects and the safety profile of the AT(1) receptor antagonist losartan in hypertensive renal transplant recipi ents. In 20 renal transplant recipients with stable renal graft function 50 mg of losartan was added to the preexisting antihypertensive treatment (no angiotensin-converting enzyme inhibitors) at least 6 months after renal tr ansplantation. Twenty-four-hour ambulatory BP, two-dimensional-guided M-mod e echocardiography, and duplex sonography, as well as renal function, red b lood cell count, cyclosporine A and FK 506 levels, erythropoetin, and angio tensin II concentration were determined at baseline and after 6 months of t herapy. With 24-h ambulatory BP measurement, systolic blood pressure (SBP) was reduced by 7.5 +/- 2.4 mm Hg and diastolic blood pressure (DBP) by 4.5 +/- 1.8 mm Hg (P <.01 and P <.05, respectively). Posterior, septal, and rel ative wall thickness decreased by 0.95 +/- 0.2 mm, 0.91 +/- 0.2 mm and 0.04 +/- 0.01 mm, respectively (all P <.001). Left ventricular mass index decre ased by 18.1 +/- 4.7 g/m(2) (P <.01). Ejection fraction and midwall fractio nal fiber shortening as systolic parameters and the relation of passive-to- active diastolic filling of the left ventricle were unaltered. Serum creati nine and cyclosporine A concentration remained stable in all patients. Hemo globin and hematocrit decreased by 1.0 +/- 0.3 g/dL and 3.6% +/- 0.9%, resp ectively (P <.002 and P <.001) without a change in serum erythropoetin leve l. In renal transplant recipients the AT, receptor antagonist losartan redu ces left ventricular hypertrophy without altering systolic or diastolic fun ction. It is safe with regard to renal function and immunosuppression, but slightly decreases hemoglobin level. Am J Hypertens 2000; 13:1295-1300 (C) 2000 American Journal of Hypertension, Ltd.