Renal and haemodynamic effects of amlodipine and nifedipine in hypertensive renal transplant recipients

Nephrol Dial Transplant. 1998 Oct;13(10):2612-6. doi: 10.1093/ndt/13.10.2612.

Abstract

Background: Immunosuppressive treatment with cyclosporin A (CsA) improves the survival of renal allografts, but is associated with renal vasoconstriction and hypertension. Previous reports suggest that the calcium-channel blockers nifedipine and amlodipine may improve graft function in CsA-treated patients. We have compared the effects of amlodipine (5-10 mg once daily) and nifedipine retard (10-40 mg twice daily) on renal function and blood pressure in renal transplant recipients treated with CsA.

Methods: This was a multicentre, two-way, crossover study in 27 evaluable hypertensive patients with renal insufficiency following renal transplantation, who were maintained on a stable dose of CsA. Patients received either amlodipine (5-10 mg once daily) or nifedipine retard (10-40 mg twice daily) for 8 weeks, and were then crossed over to the other treatment for a further 8 weeks.

Results: Trends were seen during amlodipine treatment towards larger improvements, in serum creatinine (by 8% of baseline on amlodipine vs 4% on nifedipine), lithium clearance (13% vs 2%), and glomerular filtration rate 11% vs 7%). Effective renal plasma flow was increased by 11% of baseline on nifedipine vs 9% on amlodipine. There were no significant differences between treatments. Amlodipine and nifedipine lowered systolic blood pressure to a similar extent (21 mmHg vs 15 mmHg respectively, P=0.25), but amlodipine was more effective than nifedipine in lowering diastolic blood pressure (13 mmHg vs 8 mmHg, P=0.006). Both treatments were well tolerated.

Conclusion: Once-daily amlodipine is at least as effective as twice-daily nifedipine retard in controlling blood pressure and does not adversely affect graft function in hypertensive renal allograft recipients.

Publication types

  • Clinical Trial
  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Amlodipine / therapeutic use*
  • Blood Pressure / drug effects
  • Calcium Channel Blockers / therapeutic use*
  • Cross-Over Studies
  • Cyclosporine / adverse effects
  • Cyclosporine / therapeutic use
  • Female
  • Follow-Up Studies
  • Glomerular Filtration Rate / drug effects
  • Graft Rejection / physiopathology
  • Graft Rejection / prevention & control
  • Humans
  • Hypertension / chemically induced
  • Hypertension / drug therapy*
  • Kidney / drug effects*
  • Kidney / physiopathology
  • Kidney Transplantation* / physiology
  • Male
  • Middle Aged
  • Nifedipine / therapeutic use*
  • Renal Plasma Flow / drug effects*
  • Single-Blind Method

Substances

  • Calcium Channel Blockers
  • Amlodipine
  • Cyclosporine
  • Nifedipine