Enalapril/amlodipine combination in cyclosporine-treated renal transplant recipients: a prospective randomized trial

:  Background:  Most hypertensive renal transplant recipients require two or more antihypertensive medications to achieve blood pressure control. However, which medications must be combined is still a matter of debate. Methods:  A prospective randomized open‐label blinded evaluation trial comparing...

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Veröffentlicht in:Clinical transplantation 2007-03, Vol.21 (2), p.277-284
Hauptverfasser: Halimi, Jean-Michel, Giraudeau, Bruno, Buchler, Matthias, Al-Najjar, Azmi, Etienne, Isabelle, Laouad, Inass, Bruyère, Franck, Lebranchu, Yvon
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container_end_page 284
container_issue 2
container_start_page 277
container_title Clinical transplantation
container_volume 21
creator Halimi, Jean-Michel
Giraudeau, Bruno
Buchler, Matthias
Al-Najjar, Azmi
Etienne, Isabelle
Laouad, Inass
Bruyère, Franck
Lebranchu, Yvon
description :  Background:  Most hypertensive renal transplant recipients require two or more antihypertensive medications to achieve blood pressure control. However, which medications must be combined is still a matter of debate. Methods:  A prospective randomized open‐label blinded evaluation trial comparing the six‐month effects of the amlodipine–enalapril combination (n = 32) vs. enalapril alone (n = 33) and vs. amlodipine alone (n = 34) on arterial pressure, renal function, albuminuria and tolerability. Results:  At six months, diastolic arterial pressure was more adequately controlled (i.e.,
doi_str_mv 10.1111/j.1399-0012.2007.00643.x
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However, which medications must be combined is still a matter of debate. Methods:  A prospective randomized open‐label blinded evaluation trial comparing the six‐month effects of the amlodipine–enalapril combination (n = 32) vs. enalapril alone (n = 33) and vs. amlodipine alone (n = 34) on arterial pressure, renal function, albuminuria and tolerability. Results:  At six months, diastolic arterial pressure was more adequately controlled (i.e., &lt;90 mmHg) in the combination group than in the amlodipine and enalapril groups (100% vs. 82.4% and 84.8%, respectively, p = 0.038). The same trend was observed for systolic arterial pressure (65.6% vs. 58.8% and 51.5%, NS). The six‐month change in albuminuria was similar in the combination group and in the enalapril group (−64.7% vs. −59.5%); however, patients in the combination group exhibited a greater reduction in albuminuria than in the amlodipine group (−64.7% vs. −29.0%, p = 0.002). As compared with baseline values, serum creatinine and potassium remained unchanged in the combination group, whereas they increased by 9 ± 12 μmol/L (p = 0.01) and by 0.2 ± 0.4 mmol/L (p &lt; 0.01), respectively, in the enalapril group. The cyclosporine trough levels remained unchanged in the combination group, but increased in the amlodipine group. Conclusion:  Angiotensin‐converting enzyme inhibitor (ACEI)–calcium‐channel blocker (CCB) combination controls arterial pressure more adequately than ACEI alone or CCB alone, reduces albuminuria and may prevent the ACEI‐induced initial rise in serum creatinine.</description><identifier>ISSN: 0902-0063</identifier><identifier>EISSN: 1399-0012</identifier><identifier>DOI: 10.1111/j.1399-0012.2007.00643.x</identifier><identifier>PMID: 17425758</identifier><language>eng</language><publisher>Oxford, UK: Blackwell Publishing Ltd</publisher><subject>Adult ; albuminuria ; Albuminuria - prevention &amp; control ; Amlodipine - therapeutic use ; Angiotensin-Converting Enzyme Inhibitors - therapeutic use ; Biological and medical sciences ; Blood Pressure - drug effects ; calcium channel blockers ; Calcium Channel Blockers - therapeutic use ; converting enzyme inhibitors ; Creatinine - blood ; Cyclosporine - blood ; Cyclosporine - therapeutic use ; Drug Therapy, Combination ; Enalapril - therapeutic use ; Female ; Fundamental and applied biological sciences. Psychology ; Fundamental immunology ; Humans ; hypertension ; Hypertension - prevention &amp; control ; Immunosuppressive Agents - blood ; Immunosuppressive Agents - therapeutic use ; Kidney Transplantation - immunology ; Male ; Medical sciences ; Middle Aged ; Nephrology. Urinary tract diseases ; Prospective Studies ; renal function ; renal transplantation ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery of the urinary system ; Tissue, organ and graft immunology ; Urinary system involvement in other diseases. Miscellaneous ; Urinary tract. Prostate gland</subject><ispartof>Clinical transplantation, 2007-03, Vol.21 (2), p.277-284</ispartof><rights>2007 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5003-8c511c9972fd564ae32977a5009f2d8d40c466fb5b45756d765e0ee1bdc671fd3</citedby><cites>FETCH-LOGICAL-c5003-8c511c9972fd564ae32977a5009f2d8d40c466fb5b45756d765e0ee1bdc671fd3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fj.1399-0012.2007.00643.x$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fj.1399-0012.2007.00643.x$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27903,27904,45553,45554</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&amp;idt=18619368$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/17425758$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Halimi, Jean-Michel</creatorcontrib><creatorcontrib>Giraudeau, Bruno</creatorcontrib><creatorcontrib>Buchler, Matthias</creatorcontrib><creatorcontrib>Al-Najjar, Azmi</creatorcontrib><creatorcontrib>Etienne, Isabelle</creatorcontrib><creatorcontrib>Laouad, Inass</creatorcontrib><creatorcontrib>Bruyère, Franck</creatorcontrib><creatorcontrib>Lebranchu, Yvon</creatorcontrib><title>Enalapril/amlodipine combination in cyclosporine-treated renal transplant recipients: a prospective randomized trial</title><title>Clinical transplantation</title><addtitle>Clin Transplant</addtitle><description>:  Background:  Most hypertensive renal transplant recipients require two or more antihypertensive medications to achieve blood pressure control. However, which medications must be combined is still a matter of debate. Methods:  A prospective randomized open‐label blinded evaluation trial comparing the six‐month effects of the amlodipine–enalapril combination (n = 32) vs. enalapril alone (n = 33) and vs. amlodipine alone (n = 34) on arterial pressure, renal function, albuminuria and tolerability. Results:  At six months, diastolic arterial pressure was more adequately controlled (i.e., &lt;90 mmHg) in the combination group than in the amlodipine and enalapril groups (100% vs. 82.4% and 84.8%, respectively, p = 0.038). The same trend was observed for systolic arterial pressure (65.6% vs. 58.8% and 51.5%, NS). The six‐month change in albuminuria was similar in the combination group and in the enalapril group (−64.7% vs. −59.5%); however, patients in the combination group exhibited a greater reduction in albuminuria than in the amlodipine group (−64.7% vs. −29.0%, p = 0.002). As compared with baseline values, serum creatinine and potassium remained unchanged in the combination group, whereas they increased by 9 ± 12 μmol/L (p = 0.01) and by 0.2 ± 0.4 mmol/L (p &lt; 0.01), respectively, in the enalapril group. The cyclosporine trough levels remained unchanged in the combination group, but increased in the amlodipine group. Conclusion:  Angiotensin‐converting enzyme inhibitor (ACEI)–calcium‐channel blocker (CCB) combination controls arterial pressure more adequately than ACEI alone or CCB alone, reduces albuminuria and may prevent the ACEI‐induced initial rise in serum creatinine.</description><subject>Adult</subject><subject>albuminuria</subject><subject>Albuminuria - prevention &amp; control</subject><subject>Amlodipine - therapeutic use</subject><subject>Angiotensin-Converting Enzyme Inhibitors - therapeutic use</subject><subject>Biological and medical sciences</subject><subject>Blood Pressure - drug effects</subject><subject>calcium channel blockers</subject><subject>Calcium Channel Blockers - therapeutic use</subject><subject>converting enzyme inhibitors</subject><subject>Creatinine - blood</subject><subject>Cyclosporine - blood</subject><subject>Cyclosporine - therapeutic use</subject><subject>Drug Therapy, Combination</subject><subject>Enalapril - therapeutic use</subject><subject>Female</subject><subject>Fundamental and applied biological sciences. Psychology</subject><subject>Fundamental immunology</subject><subject>Humans</subject><subject>hypertension</subject><subject>Hypertension - prevention &amp; control</subject><subject>Immunosuppressive Agents - blood</subject><subject>Immunosuppressive Agents - therapeutic use</subject><subject>Kidney Transplantation - immunology</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Nephrology. Urinary tract diseases</subject><subject>Prospective Studies</subject><subject>renal function</subject><subject>renal transplantation</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Surgery of the urinary system</subject><subject>Tissue, organ and graft immunology</subject><subject>Urinary system involvement in other diseases. Miscellaneous</subject><subject>Urinary tract. Prostate gland</subject><issn>0902-0063</issn><issn>1399-0012</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2007</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkE1v1DAQhi0EotvCX0C5wC2pHSd2grigVdkiFRCoFG6WY08kL84Hthd2-fVM2FV7xRdbM-9jjx9CMkYLhutyWzDetjmlrCxKSmVBqah4sX9EVveNx2RFW1riWfAzch7jFquCifopOWOyKmtZNyuSrkbt9Rycv9SDn6yb3QiZmYbOjTq5aczcmJmD8VOcp4C9PAXQCWwWAMksBT3G2esxYcEgDWOKrzOdzQEJMMn9ggwzdhrcH6RScNo_I0967SM8P-0X5Ou7q9v1dX7zafN-_fYmNzWlPG9MzZhpW1n2thaVBl62UmrstX1pG1tRUwnRd3VX4WeElaIGCsA6a4RkveUX5NXxXhzm5w5iUoOLBjyOC9MuKkm5bHhZYrA5Bg1OHQP0Co0MOhwUo2oxrrZqEasWsWoxrv4ZV3tEX5ze2HUD2AfwpBgDL08BHY32PcowLj7kGsFaLpbcm2Put_Nw-O8B1Pr2Cx4Qz4-4iwn297gOP5SQXNbq28eNutu0tLn7_ll94H8BQ5Stww</recordid><startdate>200703</startdate><enddate>200703</enddate><creator>Halimi, Jean-Michel</creator><creator>Giraudeau, Bruno</creator><creator>Buchler, Matthias</creator><creator>Al-Najjar, Azmi</creator><creator>Etienne, Isabelle</creator><creator>Laouad, Inass</creator><creator>Bruyère, Franck</creator><creator>Lebranchu, Yvon</creator><general>Blackwell Publishing Ltd</general><general>Blackwell</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>200703</creationdate><title>Enalapril/amlodipine combination in cyclosporine-treated renal transplant recipients: a prospective randomized trial</title><author>Halimi, Jean-Michel ; Giraudeau, Bruno ; Buchler, Matthias ; Al-Najjar, Azmi ; Etienne, Isabelle ; Laouad, Inass ; Bruyère, Franck ; Lebranchu, Yvon</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5003-8c511c9972fd564ae32977a5009f2d8d40c466fb5b45756d765e0ee1bdc671fd3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2007</creationdate><topic>Adult</topic><topic>albuminuria</topic><topic>Albuminuria - prevention &amp; control</topic><topic>Amlodipine - therapeutic use</topic><topic>Angiotensin-Converting Enzyme Inhibitors - therapeutic use</topic><topic>Biological and medical sciences</topic><topic>Blood Pressure - drug effects</topic><topic>calcium channel blockers</topic><topic>Calcium Channel Blockers - therapeutic use</topic><topic>converting enzyme inhibitors</topic><topic>Creatinine - blood</topic><topic>Cyclosporine - blood</topic><topic>Cyclosporine - therapeutic use</topic><topic>Drug Therapy, Combination</topic><topic>Enalapril - therapeutic use</topic><topic>Female</topic><topic>Fundamental and applied biological sciences. Psychology</topic><topic>Fundamental immunology</topic><topic>Humans</topic><topic>hypertension</topic><topic>Hypertension - prevention &amp; control</topic><topic>Immunosuppressive Agents - blood</topic><topic>Immunosuppressive Agents - therapeutic use</topic><topic>Kidney Transplantation - immunology</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Nephrology. Urinary tract diseases</topic><topic>Prospective Studies</topic><topic>renal function</topic><topic>renal transplantation</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Surgery of the urinary system</topic><topic>Tissue, organ and graft immunology</topic><topic>Urinary system involvement in other diseases. Miscellaneous</topic><topic>Urinary tract. Prostate gland</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Halimi, Jean-Michel</creatorcontrib><creatorcontrib>Giraudeau, Bruno</creatorcontrib><creatorcontrib>Buchler, Matthias</creatorcontrib><creatorcontrib>Al-Najjar, Azmi</creatorcontrib><creatorcontrib>Etienne, Isabelle</creatorcontrib><creatorcontrib>Laouad, Inass</creatorcontrib><creatorcontrib>Bruyère, Franck</creatorcontrib><creatorcontrib>Lebranchu, Yvon</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical transplantation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Halimi, Jean-Michel</au><au>Giraudeau, Bruno</au><au>Buchler, Matthias</au><au>Al-Najjar, Azmi</au><au>Etienne, Isabelle</au><au>Laouad, Inass</au><au>Bruyère, Franck</au><au>Lebranchu, Yvon</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Enalapril/amlodipine combination in cyclosporine-treated renal transplant recipients: a prospective randomized trial</atitle><jtitle>Clinical transplantation</jtitle><addtitle>Clin Transplant</addtitle><date>2007-03</date><risdate>2007</risdate><volume>21</volume><issue>2</issue><spage>277</spage><epage>284</epage><pages>277-284</pages><issn>0902-0063</issn><eissn>1399-0012</eissn><abstract>:  Background:  Most hypertensive renal transplant recipients require two or more antihypertensive medications to achieve blood pressure control. However, which medications must be combined is still a matter of debate. Methods:  A prospective randomized open‐label blinded evaluation trial comparing the six‐month effects of the amlodipine–enalapril combination (n = 32) vs. enalapril alone (n = 33) and vs. amlodipine alone (n = 34) on arterial pressure, renal function, albuminuria and tolerability. Results:  At six months, diastolic arterial pressure was more adequately controlled (i.e., &lt;90 mmHg) in the combination group than in the amlodipine and enalapril groups (100% vs. 82.4% and 84.8%, respectively, p = 0.038). The same trend was observed for systolic arterial pressure (65.6% vs. 58.8% and 51.5%, NS). The six‐month change in albuminuria was similar in the combination group and in the enalapril group (−64.7% vs. −59.5%); however, patients in the combination group exhibited a greater reduction in albuminuria than in the amlodipine group (−64.7% vs. −29.0%, p = 0.002). As compared with baseline values, serum creatinine and potassium remained unchanged in the combination group, whereas they increased by 9 ± 12 μmol/L (p = 0.01) and by 0.2 ± 0.4 mmol/L (p &lt; 0.01), respectively, in the enalapril group. The cyclosporine trough levels remained unchanged in the combination group, but increased in the amlodipine group. Conclusion:  Angiotensin‐converting enzyme inhibitor (ACEI)–calcium‐channel blocker (CCB) combination controls arterial pressure more adequately than ACEI alone or CCB alone, reduces albuminuria and may prevent the ACEI‐induced initial rise in serum creatinine.</abstract><cop>Oxford, UK</cop><pub>Blackwell Publishing Ltd</pub><pmid>17425758</pmid><doi>10.1111/j.1399-0012.2007.00643.x</doi><tpages>8</tpages></addata></record>
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subjects Adult
albuminuria
Albuminuria - prevention & control
Amlodipine - therapeutic use
Angiotensin-Converting Enzyme Inhibitors - therapeutic use
Biological and medical sciences
Blood Pressure - drug effects
calcium channel blockers
Calcium Channel Blockers - therapeutic use
converting enzyme inhibitors
Creatinine - blood
Cyclosporine - blood
Cyclosporine - therapeutic use
Drug Therapy, Combination
Enalapril - therapeutic use
Female
Fundamental and applied biological sciences. Psychology
Fundamental immunology
Humans
hypertension
Hypertension - prevention & control
Immunosuppressive Agents - blood
Immunosuppressive Agents - therapeutic use
Kidney Transplantation - immunology
Male
Medical sciences
Middle Aged
Nephrology. Urinary tract diseases
Prospective Studies
renal function
renal transplantation
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgery of the urinary system
Tissue, organ and graft immunology
Urinary system involvement in other diseases. Miscellaneous
Urinary tract. Prostate gland
title Enalapril/amlodipine combination in cyclosporine-treated renal transplant recipients: a prospective randomized trial
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