Andrés A, Morales E, Morales J M, Bosch I, Campo C, Ruilope L M
Hospital 12 de Octubre, Nephrology Department, Barcelona, Spain.
Transplant Proc. 2006 Oct;38(8):2419-23. doi: 10.1016/j.transproceed.2006.08.066.
The prevalence of posttransplant hypertension is high, and it appears to be a major risk factor for graft and patient survival. The aim of this study was to assess the efficacy and safety of valsartan, an angiotensin-receptor blocker (ARB), in the treatment of posttransplant hypertension.
A multinational, multicenter, prospective, randomized, double-blind, placebo-controlled study was performed on the treatment of hypertension (systolic blood pressure [BP] >/= 140 and/or diastolic BP >/= 90 mm Hg) in adult cyclosporin-treated renal transplant recipients randomized to receive either valsartan (80 mg once daily) or a matching placebo for 8 weeks. After the first 4 weeks, furosemide 20 mg twice daily was added on a open basis if systolic BP remained >/= 130 mm Hg and/or diastolic BP remained >/= 85 mm Hg.
One hundred fifteen (valsartan = 57, placebo = 58) uncontrolled hypertensive patients despite monotherapy for hypertension, other than angiotensin-converting enzyme inhibitor or ARB, were randomized. In the valsartan group, significant decreases were seen in systolic BP (from 153 +/- 11 to 140.9 +/- 18.35 mm Hg at 4 weeks, and 136.5 +/- 15 mm Hg at 8 weeks) and diastolic BP (from 93 +/- 9 to 85.2 +/- 11.28 mm Hg at 4 weeks, and 83.8 +/- 9.2 mm Hg at 8 weeks). There was no significant change in the placebo group. In the valsartan group, a statistically but not clinically significant reduction was observed in the mean hemoglobin concentration (12.9 +/- 1.6 g/dL versus 13.8 +/- 1.6 g/dL at 4 weeks, P < .01; and 12.3 +/- 1.6 versus 13.8 +/- 1.7 at 8 weeks; P < .001) as well as a significant increase in serum potassium (4.4 +/- 0.5 mmol/L versus 4.1 +/- 0.4 mmol/L at 4 weeks, P < .01) vs placebo.
Valsartan is effective in the treatment of posttransplant hypertension and is well tolerated.
移植后高血压的患病率很高，它似乎是影响移植物和患者生存的主要危险因素。本研究的目的是评估血管紧张素受体阻滞剂（ARB）缬沙坦治疗移植后高血压的有效性和安全性。
对接受环孢素治疗的成年肾移植受者的高血压（收缩压[BP]≥140和/或舒张压BP≥90mmHg）治疗进行了一项多国、多中心、前瞻性、随机、双盲、安慰剂对照研究，随机分为接受缬沙坦（80mg每日一次）或匹配安慰剂治疗8周。在最初4周后，如果收缩压仍≥130mmHg和/或舒张压仍≥85mmHg，则在开放基础上加用呋塞米20mg每日两次。
115例（缬沙坦组=57例，安慰剂组=58例）尽管接受了除血管紧张素转换酶抑制剂或ARB以外的高血压单一疗法但仍未控制的高血压患者被随机分组。在缬沙坦组中，收缩压显著降低（4周时从153±11降至140.9±18.35mmHg，8周时为136.5±15mmHg），舒张压也显著降低（4周时从93±9降至85.2±11.28mmHg，8周时为83.8±9.2mmHg）。安慰剂组无显著变化。在缬沙坦组中，观察到平均血红蛋白浓度有统计学意义但无临床意义的降低（4周时为12.9±1.6g/dL对13.8±1.6g/dL，P<.01；8周时为12.3±1.6对13.8±1.7；P<.001），血清钾与安慰剂相比有显著升高（4周时为4.4±0.5mmol/L对4.1±0.4mmol/L，P<.01）。
缬沙坦治疗移植后高血压有效且耐受性良好。
