Hricik D E
Clin Nephrol. 1987 May;27(5):250-9.
The acute and chronic antihypertensive and renal effects of the angiotensin converting enzyme inhibitor, enalapril, were studied prospectively in ten hypertensive renal transplant recipients. Acute administration of enalapril produced a significant decrement in both systolic and diastolic blood pressure but had no significant effect on glomerular filtration rate or effective renal plasma flow. The antihypertensive effect of enalapril was enhanced by gradually increasing the dose of the drug or by addition of a diuretic during six to eight weeks of chronic therapy. During chronic enalapril therapy, four patients developed renal insufficiency that reversed after discontinuation of the drug. In three of these four cases, overt renal insufficiency was associated temporally with the addition of a diuretic. Digital angiography revealed unequivocal transplant renal-artery stenosis in three of the four patients with renal insufficiency; the fourth patient had diffuse narrowing of the transplant renal artery without a discrete stenosis. It is concluded that enalapril alone or in combination with a diuretic is effective in lowering blood pressure in patients with post-transplant hypertension. The development of renal insufficiency during enalapril therapy may be exacerbated by concomitant diuretic therapy and should raise the suspicion of underlying transplant renal-artery stenosis. The acute blood pressure or renal response to a small dose of enalapril does not reliably predict the development of renal insufficiency during treatment with larger doses of the drug.
对10例高血压肾移植受者前瞻性地研究了血管紧张素转换酶抑制剂依那普利的急慢性降压及肾脏效应。急性给予依那普利可使收缩压和舒张压显著降低，但对肾小球滤过率或有效肾血浆流量无显著影响。在6至8周的慢性治疗期间，通过逐渐增加药物剂量或加用利尿剂可增强依那普利的降压效果。在慢性依那普利治疗期间，4例患者出现肾功能不全，停药后肾功能恢复。在这4例患者中的3例，明显的肾功能不全在时间上与加用利尿剂有关。数字血管造影显示，4例肾功能不全患者中有3例存在明确的移植肾动脉狭窄；第4例患者移植肾动脉弥漫性狭窄，无明显狭窄。得出的结论是，依那普利单独使用或与利尿剂联合使用对移植后高血压患者有效降低血压。依那普利治疗期间肾功能不全的发生可能因同时使用利尿剂而加重，应怀疑存在潜在的移植肾动脉狭窄。小剂量依那普利的急性血压或肾脏反应不能可靠地预测大剂量该药物治疗期间肾功能不全的发生。
