Antihypertensives for kidney transplant recipients: systematic review and meta-analysis of randomized controlled trials

• Published in: Transplantation Vol. 88; no. 1; p. 7
• Main Authors: Cross, Nicholas B, Webster, Angela C, Masson, Philip, O'connell, Philip J, Craig, Jonathan C
• Format: Journal Article
• Language: English
• Published: United States 15.07.2009
• Subjects: Angiotensin-Converting Enzyme Inhibitors - adverse effects; Angiotensin-Converting Enzyme Inhibitors - therapeutic use; Antihypertensive Agents - adverse effects; Antihypertensive Agents - therapeutic use; Blood Pressure - drug effects; Calcium Channel Blockers - adverse effects; Calcium Channel Blockers - therapeutic use; Glomerular Filtration Rate - drug effects; Graft Survival - drug effects; Humans; Hypertension - drug therapy; Hypertension - physiopathology; Kidney Transplantation - adverse effects; Practice Guidelines as Topic; Randomized Controlled Trials as Topic; Risk Assessment; Treatment Outcome
• ISSN: 1534-6080
• DOI: 10.1097/TP.0b013e3181a9e960

In nontransplant populations, effects of different antihypertensive drug classes vary. Relative effects in kidney transplant recipients are uncertain. We performed a systematic review including random effects meta-analysis of randomized controlled trials, using Cochrane Collaboration methodology. We identified 60 trials, enrolling 3802 recipients. Twenty-nine trials (2262 patients) compared calcium channel blockers (CCB) with placebo or no treatment, 10 trials (445 patients) compared angiotensin-converting enzyme inhibitors (ACEi) with placebo or no treatment, and seven studies (405 patients) compared CCB with ACEi. CCB compared with placebo or no treatment (plus additional agents in either arm as required) reduced graft loss (risk ratio [RR] 0.75, 95% confidence intervals [CI] 0.57-0.99) and improved glomerular filtration rate (GFR; mean difference [MD] 4.5 mL/min, 95% CI 2.2-6.7). Data on ACEi versus placebo or no treatment were inconclusive for GFR (MD -8.1 mL/min, 95% CI -18.6-2.4) and inconsistent for graft loss, precluding meta-analysis. In direct comparison with CCB, ACEi decreased GFR (MD 11.5 mL/min, 95% CI 7.2-15.8), proteinuria (MD 0.28 g/day, 95% CI 0.10-0.47), hemoglobin (MD 11.5 g/L, 95% CI 7.2-15.8), and increased hyperkalemia (RR 3.7, 95% CI 1.9-7.7). Graft loss data were inconclusive (RR 7.4, 95% CI 0.4-140). These data suggest that CCB may be preferred as first-line agents for hypertensive kidney transplant recipients.