ACE Inhibitors and Persistent Left Ventricular Hypertrophy After Renal Transplantation: A Randomized Clinical Trial

Paoletti, Ernesto; Cassottana, Paolo; Amidone, Marco; Gherzi, Maurizio; Rolla, Davide; Cannella, Giuseppe

doi:10.1053/j.ajkd.2007.04.013

« Previous Next »American Journal of Kidney Diseases
Volume 50, Issue 1 , Pages 133-142, July 2007

ACE Inhibitors and Persistent Left Ventricular Hypertrophy After Renal Transplantation: A Randomized Clinical Trial

Part of this study was presented orally at the 2007 World Congress of Nephrology, Rio de Janeiro, Brazil, April 21-25, 2007, and published in abstract form in the Proceedings of the Congress.

Ernesto Paoletti, MD
- Divisione di Nefrologia, Dialisi e Trapianto, Azienda Ospedaliera Universitaria S. Martino, Genova, Italy.
- Address correspondence to Ernesto Paoletti, MD, Divisione di Nefrologia, Dialisi e Trapianto, Azienda Ospedaliera Universitaria S. Martino, Lgo R. Benzi 10, 16132, Genova, Italy.
Paolo Cassottana, MD
- Divisione di Cardiologia. Azienda Ospedaliera Universitaria S. Martino, Genova, Italy.
Marco Amidone, MD
- Divisione di Nefrologia, Dialisi e Trapianto, Azienda Ospedaliera Universitaria S. Martino, Genova, Italy.
Maurizio Gherzi, MD
- Divisione di Nefrologia, Dialisi e Trapianto, Azienda Ospedaliera Universitaria S. Martino, Genova, Italy.
Davide Rolla, MD
- Divisione di Nefrologia, Dialisi e Trapianto, Azienda Ospedaliera Universitaria S. Martino, Genova, Italy.
Giuseppe Cannella, MD, PhD
- Divisione di Nefrologia, Dialisi e Trapianto, Azienda Ospedaliera Universitaria S. Martino, Genova, Italy.

Received 1 November 2006; accepted 13 April 2007. published online 30 May 2007.

Background

Interventional studies of left ventricular hypertrophy (LVH) in renal transplant recipients are scarce and to date evaluated only patients immediately after renal transplantation.

Study Design

Randomized controlled trial that assessed the effectiveness of angiotensin-converting enzyme (ACE) inhibitors in regressing persistent LVH after successful transplantation.

Setting & Participants

70 renal transplant recipients (47 men; age, 30 to 68 years) without diabetes previously randomly assigned to either cyclosporine or tacrolimus therapy, with LVH persisting 3 to 6 months after transplantation.

Intervention

Subjects were randomly assigned to either lisinopril (ACE-inhibitor group; 36 patients) or no therapy (control group; 34 subjects).

Outcomes

Main outcome was change in left ventricular mass index (LVMi) at month 18.

Results

A consistent decrease in both systolic (SBP) and diastolic blood pressure (DBP) was observed in both groups (between-group differences, −1.7 ± 3.3 mm Hg; 95% confidence interval [CI], −4.8 to 8.2; P = 0.6 for SBP; 0.3 ± 2.2 mm Hg; 95% CI, −4.8 to 4.1; P = 0.9 for DBP), whereas LVMi regressed more in the ACE-inhibitor group (between-group difference, 10.1 ± 16.3 g/m^2.7; 95% CI, 4.2 to 16.1; P < 0.01). A significant interaction of ACE inhibitors with cyclosporine in affecting LVMi change was shown by means of post hoc multiple regression analysis (P < 0.01; differences between cyclosporine and tacrolimus group, 13.3 ± 3.9 g/m^2.7; 95% CI, 5.3 to 21.2; P < 0.01 in the ACE-inhibitor group; 3.7 ± 4.2 g/m^2.7; 95% CI, −4.7 to 12.2; P = 0.4 in the control group).

Limitations

Single-center study with small sample size. Interaction of ACE inhibitors with cyclosporine treatment emerged from post hoc analysis.

Conclusion

A prolonged course of ACE-inhibitor therapy is effective in regressing the persistent LVH of renal transplant recipients by mechanisms independent of effects on BP. This regression seems to be at least in part the effect of an interaction between ACE inhibitors and cyclosporine.

Index Words: Left ventricular hypertrophy, renal transplant recipients, angiotensin-converting enzyme (ACE) inhibitors, cyclosporine, tacrolimus