Randomized prospective study of effects of benazepril in renal transplantation: an analysis of safety and efficacy

Background. Prolonging the survival of transplanted kidneys is one of major tasks of modern nephrology. Angiotensin-converting enzyme inhibitors (ACEIs) compose a class of antihypertensive agents that has established efficacy in the treatment of hypertension and in slowing the progression of diabetic nephropathy and chronic glomerulonephritis. ACEIs are not widely accepted as a standard medication in the treatment of hypertension in renal transplant recipients because of the potential risk for decreased renal blood flow and glomerular filtration rate associated with a single kidney and concomitant cyclosporin use. Methods. We undertook a prospective randomized study of ACEI (benazepril) treatment in 76 posttransplant patients to determine the safety, efficacy, and side-effect profile of benazepril. Forty-one patients were assigned to the benazepril group and 35 patients were assigned to the control group. Results. The mean arterial blood pressure at a 12-month follow-up was lower than that at the time of initiation of benazepril or control therapy, with a decrease from 101 ± 10 mmHg to 94 ± 7 mmHg (P < 0.05) in the benazepril group and from 102 ± 12 mmHg to 94 ± 10 mmHg in the control group after 12 months of treatment. The serum creatinine concentrations did not change throughout the follow-up period. Conclusions. Benazepril was demonstrated to be an effective antihypertensive without any unfavorable effects on graft function. A significant antiproteinuric effect of benazepril was observed in patients with overt proteinuria. Further follow-up of this patient population will contribute to the establishment of the long-term renoprotective effect of benazepril in renal allograft recipients.