Nephrol Dial Transplant (2001) 16: 1465-1470
© 2001 European Renal Association-European Dialysis and Transplant Association
Better microvascular function on long-term treatment with lisinopril than with nifedipine in renal transplant recipients
Laboratory for Renal Physiology, Section of Nephrology, Medical Department, The National Hospital, Oslo, Norway
Background. The prevalence of hypertension in renal transplant recipients is high but the pathophysiology is poorly defined. Impaired endothelial function may be a factor of major importance. The present study addresses the effects of long-term treatment with either lisinopril or slow-release nifedipine on microvascular function and plasma endothelin in renal transplant recipients on cyclosporin A (CsA).
Methods. Seventy-five hypertensive renal transplant recipients were double-blind randomized to receive slow-release nifedipine (NIF, n=40) or lisinopril (LIS, n=35). Ten normotensive, age-matched recipients served as controls. All patients received CsA-based immunosuppressive therapy including prednisolone and azathioprine. Microvascular function was assessed in the forearm skin vasculature, using laser Doppler flowmetry in combination with post-occlusive reactive hyperaemia and endothelial-dependent function during local acetylcholine (ACh) stimulation.
Results. The analysis of microvascular function (AUCrh) showed that nifedipine-treated patients had significantly lower responses compared with lisinopril-treated patients (20±17 and 43±20 AUxmin respectively, P=0.0016). Endothelial function was borderline significantly lower in the NIF group compared with the LIS group (640±345 and 817±404 AUxmin respectively, P=0.056). The responses in the LIS group were comparable with those in non-hypertensive controls (AUCrh was 37±16 and AUCACh was 994±566 AUxmin). Plasma endothelin-1 concentrations were significantly higher in the NIF group compared with the LIS group (0.44±0.19 vs 0.34±0.10 fmol/ml respectively, P=0.048), and were 0.29±0.09 fmol/ml in the control patients. AUCACh was associated with plasma endothelin-1 (P=0.0053), while AUCrh was not (P=0.080).
Conclusions. The study indicates that long-term treatment with lisinopril, when compared with nifedipine, yields a more beneficial effect on microvascular function in hypertensive renal transplant recipients on CsA. The beneficial microvascular effect may be mediated in part by an endothelin-1-associated effect on the endothelium.
Keywords: cyclosporin; endothelin; hypertension; kidney; microvascular function; transplantation
Correspondence and offprint requests to: Anders Åsberg, Laboratory for Renal Physiology, Section of Nephrology, C11027, Medical Department, The National Hospital, N-0027 Oslo, Norway.
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  A. Asberg, A. Hartmann, E. Fjeldsa, and H. Holdaas Atorvastatin improves endothelial function in renal-transplant recipients Nephrol. Dial. Transplant., September 1, 2001; 16(9): 1920 - 1924. [Abstract] [Full Text] [PDF]
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