Hippokratia 2000, 4(2):67-72
G Vergoulas, Gr. Miserlis, G. Trellopoulos, A. Antoniadis
Abstract
Arterial hypertension is a major risk factor for cardiovascular morbidity and mortality in renal transplant recipients. Cyclosporine and FK-506 contribute on the development of hypertension. Losartan, a blocker of angiotensin II receptors (ATI), has been proved to be an effective antihypertensive agent. The present retrospective study evaluated the efficacy and safety of losartan in a group of hypertensive patients with normal graft function. Nineteen patients on therapy with antihypertensive drugs were included in the study because of bad blood pressure control and / or drug side effects. These patients (14 men) received losartan 2.9 years after transplantation at the dose of 25-100 mg/d. All patients of the study had serum creatinine levels ≤1.5 mg/dl before treatment with losartan and a twelve month follow up. Systolic (SBP) and diastolic (DBP) blood pressure, serum creatinine (Scr), Ht and Hb were recorded every two months for a period of six months before (BLT) and after initiation of losartan treatment (ALT). Proteinuria and number of antihypertensive agents were recorded BLT (time 0) and six months later. ANOVA for repeated measures, regression analysis for curve estimation and paired t test were used for statistical analysis (SPSS for windows version 9.0).SBP/DBP were 140.71±13.28/86.42±15.34 mmHg, 140.35±13.93/ 90.00±9.60 mmHg, 137.85 ±13.82/91.42±8.86 mmHg, 139.28±13.98/91.07±9.84 mmHg 6, 4, 2 and 0 months BLT respectively (p=NS) and 137.10±8.38/ 85.26±6.55 mmHg, 139.73±13.48/88.15±7.49 mmHg and 142.10±14.65/88.68±7.60 mmHg 2, 4 and 6 months ALT respectively (p=NS). The number of antihypertensive agents per patient was 2.05±0.70/l.68±0.74 (p=0.015), proteinuria was 0.65±0.28/0.52±0.37 g/24h (p=NS) and losartan dose was 50.00±14.43/61.84±24.10 mg/d (p=NS) at time 0 and six months ALT respectively. Scr was 1.14±0.27 mg/dl, 1.17±0.31 mg/dl, 1.20±0.34 mg/dl and 1.12±0.25 mg/dl 6, 4, 2 and 0 months BLT respectively (p=NS, Scr slope =0.00) and 1.18±0.25 mg/dl, 1.21±0.24 mg/dl and 1.23±0.25 mg/dl 2, 4 and 6 months ALT initiation respectively (p=0.038, Scr slope =+0.02). Ht/Hb were 45.94±5.21 %/l4.4±2.06 g/dl, 46.15±5.24% /14.99±1.68 g/dl, 46.20±5.91%/14.98±1.90 g/dl, 46.70±5.42%/15.27±1.74 g/dl 6, 4, 2 and 0 months BLT respectively (p=NS) and 44.28+5.30%/14.26+2.01g/dl,42.83±6.10%/13.98±1.90g/dl,42.24±6.26%/13.81±1.98 g/dl at 2, 4 and 6 months ALT initiation respectively (p=0.02/0.008 respectively). These results show that losartan controls efficiently the blood pressure of hypertensive renal transplant recipients, lowers significantly the need for other antihypertensive agents, causes a significant fall of Ht/Hb and a small but significant rise of serum creatinine level.