Amlodipine reduces cyclosporin-induced hyperuricaemia in hypertensive renal transplant recipients
Amlodipine reduces cyclosporin-induced hyperuricaemia in hypertensive renal transplant recipients
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DOI：
10.1093/ndt/gfg341
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发表时间：
2003-10-01
影响因子：
6.1
通讯作者：
Moulin, B
中科院分区：
文献类型：
--
作者：
Chanard, J;Toupance, O;Moulin, B
背景资料。高血压和高尿酸血症是环孢素A(CsA)治疗肾移植受者的常见副作用。钙通道阻滞剂氨氯地平在这类患者中能有效控制环孢素A引起的高血压，但最近的证据表明，氨氯地平也可以降低高尿酸血症。本研究旨在比较钙通道阻滞剂氨氯地平(5-10 mg/d)和β-受体拮抗剂特替洛尔(5-10 mg/d)对肾移植术后高血压患者环孢素A(CsA)所致高尿酸血症的影响。48例接受稳定剂量环孢素A的高血压肾移植患者随机双盲平行分组，分别接受氨氯地平(n=24)和特替洛尔(n=24)治疗60天。主要的结果衡量指标是血清尿酸浓度与基线的变化。根据肾功能和血压的变化进行二次疗效分析。氨氯地平显著降低血尿酸水平，从483+/-99降至431+/-10 Mumol/L(P<；0.001)，而特替洛尔显著升高血尿酸水平，从45098升至476 84 Mumol/L(P=0.006)。氨氯地平还显著增加肾小球滤过率(P=0.0048)和尿酸清除率(P=0.023)，降低肾小管近端钠重吸收分数(P<；0.001)。肾血浆流量和滤过分数不受两种治疗方法的影响，CsA血药浓度也不受影响。氨氯地平降低收缩压的幅度明显大于特替洛尔(P=0.007)。治疗组之间的舒张压随时间变化的曲线没有显著差异。两种药物均耐受性良好。氨氯地平治疗肾移植受者环孢素A所致高血压和高尿酸血症可能比特替洛尔更合适。
Background. Hypertension and hyperuricaemia are common side-effects of cyclosporin A (CsA) treatment in renal transplant recipients. While it is well established that the calcium channel blocker amlodipine can control CsA-induced hypertension effectively in this patient population, recent evidence suggests amlodipine might also reduce hyperuricaemia. The present study was designed to compare the effects of the calcium channel blocker amlodipine (5-10mg/day) and the beta-adrenoceptor antagonist tertatolol (5-10mg/day) on CsA-induced hyperuricaemia in post-renal transplant recipients with hypertension.Methods. Forty-eight hypertensive renal transplant recipients on a stable dose of CsA were randomized in a double-blind, parallel-group manner to receive either amlodipine (n = 24) or tertatolol (n = 24) for 60 days. The primary outcome measure was the change from baseline in serum uric acid concentration. Secondary analyses of efficacy were based on changes in renal function and blood pressure.Results. Amlodipine significantly decreased serum uric acid levels from 483 +/- 99 to 431 +/- 10 mumol/l (P < 0.001), while tertatolol significantly increased uric acid from 450 98 to 476 84 mumol/l (P = 0.006). Amlodipine also significantly increased glomerular filtration rate (P = 0.0048) and the clearance rate of uric acid (P=0.023) and it reduced the fractional proximal tubular reabsorption of sodium (P < 0.001), compared with tertatolol. Renal plasma flow and filtered fraction were unaffected by both treatments, as was trough CsA blood concentration. Amlodipine lowered systolic blood pressure to a significantly greater extent than did tertatolol (P=0.007). The time-dependent profile of diastolic blood pressure did not differ significantly between treatment groups. Both drugs were well tolerated.Conclusions. Amlodipine could be more appropriate than tertatolol for CsA-induced hypertension and hyperuricaemia in renal transplant recipients.