Hippokratia 2001, 5(4):156-164
G Vergoulas, Gr Miserlis, V Papanikolaou, D Gakis, I Katsara, E Atmatzidis, D Takoudas, A Antoniadis
Arterial hypertension is a major risk factor for cardiovascular morbidity and mortality in renal transplant recipients. Steroids, cyclosporine A (CsA) and FK-506 contribute in the development of hypertension. Losartan and Valsartan, angiotensin II receptor type 1 antagonists (AT1), have been proved to be effective antihypertensive agents in the general population and in the renal transplant recipients. The purpose of the present retrospective study was to compare the safety and efficacy of losartan (L) and valsartan (V) in the treatment of hypertensive renal transplant (Rt) recipients.Sixty four renal transplant recipients on antihypertensive therapy were included in the study because of inadequate blood pressure control, drug side effects or proteinuria. Three patients were withdrawn from the study because of inappropriate serum creatinine elevation. Forty patients (28 men), 41 years old, received L3.86 years after renal transplantation at the dose of 25-100 mg/d and 21 patients (16 men), 41 years old, received V 4.21 years after renal transplantation (p:NS) at the dose of 80-160 mg/d. Systolic blood pressure (SBP), diastolic blood pressure (DBP), serum creatinine levels (CRs), K, uric acid, Ht and Hb were recorded before and every two months for a period of six months after L or V initiation. Proteinuria, number of antihypertensive agents, cyclosporine A (neoral) dose and blood levels were recorded before and at the end of the six month period. The percentage of abnormal blood pressure readings was calculated before and during the patients follow up. Doubly multivariate repeated measures analysis of variance, repeated measures analysis of variance, Mc Nemar and independent t tests were used for statistical analysis.
Multivariate analysis showed that patients on V had statistically significantly (ss) lower DBP compared with patients on L (p: 0.037). SBP/DBP was 145.17±15.78/91.60±9.72 mmHg, 138.03 ±10.74/87.14±7.98 mm Hg, 142.00±15.67/ 88.57±7.68 mmHg and 143.03±14.85/ 90.35±8.15 mmHg before 2, 4 and 6 months on L treatment respectively (pins/NS). SBP/DBP was 153.50±12.25/90.5±9.71 mmHg, 142.00 ± 9.92 / 85.25±6.78 mmHg, 137.25 ± 10.93 / 85.75±6.74 mmHg and 133.25±8.92/84.00±5.98 mmHg before 2, 4 and 6 months on V treatment respectively (p:0.0005/NS). The number of abnormal blood pressure readings was reduced ss in the V group (p: 0.001). The number of antihypertensive agents per patient was 2.00+0.87/2.09±0.83 before (L/V) and 1.67 ± 0.85 (p:0.001)/1.47±0.60 (p.0.001) after 6 months (L/V). CRs was 1.61 ±0.81/1.28±0.32 mg/dl, 1.64±0.77/1.36±0.36 mg/dl, 1.66±0.86/1.40±0.37 mg/dl and 1.68±0.88/l.34±0.32 mg/dl before 2, 4, and 6 months on L/V (p:NS/0.036) treatment respectively. Hb was 13.63±2.72/13.15±2.05 g/dl, 13.39+2.28/12.65±1.93 g/dl, 13.00±2.18/12.51±2.01 g/dl and 12.85±2.26/ 12.55±2.10 g/dl before 2, 4 and 6 months on L/V (p:0.002/0.002) treatment respectively.Valsartan is more potent than losartan as far as the reduction of DBP in the recommended doses and reduces ss the high abnormal blood pressure readings. L and V control efficiently SBP and DBP of hypertensive Rt recipients, lower significantly the need for other antihypertensive agents and cause significant fall of Hb.