Efficacy and safety of ramipril therapy in hypertension after renal transplantation

Abstract

The efficacy of the new ACE-inhibitor ramipril in the treatment of hypertension is well established, but there is no experience with the use of ramipril in hypertensive renal recipients. In the present study, the efficacy and safety of the antihypertensive therapy with ramipril was examined in 10 untreated, hypertensive, renal transplant recipients with stable transplant function. For control, 10 age- an sex-matched renal transplant patients receiving conventional antihypertensive treatment with a Ca²⁺ channel blocker and/or diuretic were followed. Starting with 2.5 mg/day, the dose of Ramipril was increased to 5 mg and 10 mg at intervals of 5 days as long as diastolic blood pressure dropped below 90 mmHg. Twentyfour-hour blood pressure monitoring was performed before, 2 weeks, 6 weeks, and 12 weeks after ramipril therapy. Twentyfour-hour blood pressure was 155.8±7.1/96.1 ±3.0 mmHg before the Ramipril therapy and dropped to 147.6±3.73/87.5±3.1 mmHg after 2 weeks 140.6 ±5.4/84.5±2.4 mmHg after 6 weeks, and 138.5±5.7/83. 1±3.1 mmHg after 12 weeks of therapy. In the control group, the effect of antihypertensive treatment was not significantly different. The renal transplant function improved during the therapy with ramipril. The cyclosporin A level did not change significantly during the therapy, [cyclosporin A (HPLC) 101.4±15.9 g/l before, 98.3±15.7 g/l after 2 weeks, 94.8±13.1 g/l after 6 weeks, and 96.2±12.3 g/l after 12 weeks of ramipril therapy]. No anemia was induced by the therapy with ramipril. The potassium remained unchanged before, 2,6, and 12 weeks after the treatment with ramipril. The results show that ramipril is a safe and efficient drug for treating hypertension in renal transplant recipients.