Reduction of left ventricular mass by lisinopril and nifedipine in hypertensive renal transplant recipients: A prospective randomized double-blind study

Background, Cardiovascular disease is the dominant cause of death in renal transplant recipients. Left ventricular hypertrophy (LVH) is a known risk f actor. After renal transplantation, persistent hypertension is an important determinant for the further evolution of LVH, The aim of the present study was to compare the effect of an angiotensin converting enzyme (PLCE) inhib itor (lisinopril) with a calcium channel blocker (CCB) (controlled release nifedipine) in treatment of posttransplant hypertension focusing on changes in LVH. Methods. One hundred fifty-four renal transplant recipients presenting with hypertension (diastolic BP greater than or equal to 95 mmHg) during the fi rst 3 weeks after transplantation were randomized to receive double-blind 3 0 mg nifedipine or 10 mg lisinopril once daily. Results. One hundred twenty-three patients completed 1 year of treatment. G ood quality echocardiographic data were available in 116 recipients (62 nif edipine/54 lisinopril) 2 and 12 months posttransplant. Blood pressure was e qually well controlled in the two groups throughout the study (mean systoli c/diastolic +/- SD after 1 year: 140 +/- 16/87 +/-8 mmHg with nifedipine an d 136 +/- 17/ 85 +/-8 mmHg with lisinopril), Left ventricular mass index wa s reduced by 15% (P <0.001) in both groups (from 153 +/- 43 to 131 +/- 38 g /m(2) with nifedipine and from 142 +/- 35 to 121 +/- 34 g/m(2) with lisinop ril), There were no statistically significant differences between the two t reatment groups at baseline or at follow-up. Conclusions. In hypertensive renal transplant recipients with well-controll ed blood pressure, there is a regression of left ventricular mass after ren al transplantation. The regression of left ventricular mass index is observ ed to a similar extent in patients treated with lisinopril or nifedipine.