Comparison of Perindopril and Amlodipine in Cyclosporine-Treated Renal Allograft Recipients

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Abstract
The objective of this study was to compare the antihypertensive efficacy and influence on renal function of perindopril and amlodipine in cyclosporine-treated renal allograft recipients with mild to moderate hypertension. We conducted a randomized, double-blind, double-dummy crossover trial in ambulatory patients. Four phases were conducted: 2 weeks on placebo, 8 weeks of maintenance (perindopril or amlodipine), and 2 weeks of washout between treatment periods. Ten hypertensive patients with stable renal allograft function transplanted more than 6 months previously and receiving cyclosporine as part of their immunosuppressive regimen were studied. The patients were allocated to perindopril (2 or 4 mg/d) and amlodipine (5 mg/d) in a random sequence. If office diastolic pressure was greater than or equal to 90 mm Hg after 4 weeks, the dosage was doubled and continued for another 4 weeks. The main outcome measures were office and 24-hour ambulatory blood pressure changes after 8 weeks of active treatment and treatment and time effect on glomerular filtration rate and effective renal plasma flow. Perindopril and amlodipine were equally effective in lowering office blood pressure and similarly efficacious for the 24-hour period of the day. Neither drug affected glomerular filtration rate or effective renal plasma flow. Both agents demonstrated equivalent capacity (time×treatment, P =.955) to reverse renal vascular resistance (amlodipine from 0.35±0.02 to 0.30±0.02 mm Hg/mL per minute per 1.73 m 2 ; perindopril from 0.36±0.03 to 0.32±0.01) (time effect of all treatments together, P =.043). After amlodipine, hemoglobin was higher (148±5 versus 135±5 g/L, P =.002) and serum uric acid was lower (351±17 versus 398±24 μmol/L, P =.001) compared with perindopril.