Angiotensin-converting enzyme inhibitors (ACEi) are a class of
antihypertensive agents that decrease mortality in
congestive heart failure and have established efficacy in the treatment of
hypertension and the slowing of established
diabetic nephropathy and other
proteinuria-associated
glomerulonephritides. These drugs have not gained wide acceptance in the treatment of
hypertension in renal transplant recipients (RTRs) because of a potential for decreased renal blood flow and glomerular filtration rate associated with a
single kidney and concomitant
cyclosporine use. Experimental animal models suggest that ACEi may be of benefit in slowing the progression of chronic renal allograft rejection. We undertook a retrospective chart analysis of all RTRs in our institution who had been treated with an ACEi or an
angiotensin II (AT II) antagonist, with the objectives of determining the safety, efficacy, and side effect profile of these medications. The minimum follow-up period was 6 months. One hundred seventy-seven of 642 RTRs were prescribed an ACEi or AT II antagonist. Forty-seven patients discontinued
therapy, with the most common causes of discontinuation being
cough (8 patients) and
hyperkalemia (6 patients). The mean arterial blood pressure at each follow-up period was lower than that at the time of initiation of ACEi or AT II antagonist
therapy, with a decrease from 92 +/- 12 mm Hg to 86 +/- 9 mm Hg (P < 0.05) after 3 years of treatment. The serum
creatinine concentrations did not change throughout the follow-up period. There was a nonsustained increase from the baseline serum
potassium of 4.4 +/- 0.5 to 4.6 +/- 0.6 mEq/L at 3 months (P < 0.05), but no further increases in
potassium beyond this time. The mean
hemoglobin concentration for the cohort did not change, but 13 RTRs given an ACEi for posttransplantation
erythrocytosis (PTE) had a decrease in
hemoglobin from 17.1 +/- 1.0 g/dL at the start of ACEi
therapy to 14.8 +/- 2.2 g/dL at 3 years (P < 0.05). ACEi and AT II antagonists were generally effective
antihypertensives, and were safe and well-tolerated agents in this cohort of RTRs. ACEi were also effective in the treatment of PTE.