Document Detail

Chronic angiotensin-converting enzyme inhibition may improve sodium excretion in cardiac transplant hypertension.
MedLine Citation:
PMID:  7709462     Owner:  NLM     Status:  MEDLINE    
Cyclosporine-associated hypertension (CAH) may be mediated in part by sodium and volume retention. To investigate this issue, we studied the effects of a calcium antagonist, nitrendipine (NIT, 10-20 mg b.i.d.), and a converting enzyme inhibitor, lisinopril (LIS, 10-20 mg o.d.), on blood pressure (office BP, 24 hr ambulatory BP), excretion of an acute sodium load (200 mmol/2 hr i.v.), glomerular filtration rate (insulin clearance), cumulative dopamine excretion, plasma atrial natriuretic peptide (ANP), and endothelin excretion in 8 patients with CAH after cardiac transplantation in a double-blind, randomized, crossover trial for 6 weeks. Five patients received a diuretic during the trial at a constant dose. Office diastolic BP (DBP) decreased significantly with LIS from 97 +/- 6 to 87 +/- 9 mmHg and with NIT from 96 +/- 7 to 92 +/- 12 mmHg. Ambulatory 24 hr DBP decreased significantly from 96 +/- 7 mmHg to 86 +/- 10 mmHg (LIS) and to 84 +/- 11 mmHg (NIT). Ambulatory DBP during the day was lowered significantly from 98 +/- 11 mmHg to 87 +/- 10 mmHg (LIS) and to 88 +/- 9 mmHg (NIT) and during the night from 95 +/- 9 mmHg to 86 +/- 8 mmHg (LIS) and to 79 +/- 7 mmHg (NIT). Cumulative sodium excretion 6 hr after an acute sodium load increased to 52 +/- 39 mmol (placebo), 96 +/- 44 mmol (LIS, P < 0.05 vs. placebo), and 71 +/- 34 mmol (NIT). Glomerular filtration rate, cumulative dopamine excretion, ANP, and endothelin excretion did not differ between either treatment group. We conclude, that: (1) both drugs were similar in lowering office BP and during the day, but NIT tended to be more effective during the night; and (2) cumulative sodium excretion during LIS was significantly increased compared with placebo. There was a similar trend during NIT also. Therefore, it is possible that chronic angiotensin-converting enzyme inhibition and possibly calcium antagonists might improve the sodium-retaining state in CAH independent of differences in blood pressure, ANP, dopamine, or renal function.
G K Schwietzer; A Hartmann; G Kober; E Jungmann; D Stratmann; M Kaltenbach; W Schoeppe
Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Transplantation     Volume:  59     ISSN:  0041-1337     ISO Abbreviation:  Transplantation     Publication Date:  1995 Apr 
Date Detail:
Created Date:  1995-05-11     Completed Date:  1995-05-11     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0132144     Medline TA:  Transplantation     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  999-1004     Citation Subset:  IM    
Department of Internal Medicine, Johann Wolfgang Goethe-Universität, Frankfurt/Main, Germany.
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MeSH Terms
Angiotensin-Converting Enzyme Inhibitors / pharmacology*
Blood Pressure
Body Weight
Creatinine / blood
Cross-Over Studies
Cyclosporine / adverse effects,  blood
Dopamine / metabolism
Double-Blind Method
Glomerular Filtration Rate
Heart Transplantation / adverse effects*
Hypertension / chemically induced,  etiology*,  urine*
Kidney / physiology
Lisinopril / pharmacology
Middle Aged
Natriuresis / drug effects*
Nitrendipine / pharmacology
Reg. No./Substance:
0/Angiotensin-Converting Enzyme Inhibitors; 39562-70-4/Nitrendipine; 59865-13-3/Cyclosporine; 60-27-5/Creatinine; 83915-83-7/Lisinopril

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