Neal, D.A.J.; Brown, M.J.; Wilkinson, I.B.; Alexander, G.J.M.
April 2003
Gut;Apr2003 Supplement 1, Vol. 52, pA103
Academic Journal
Background: Hypertension develops in over 50% of patients after liver transplant. Arterial stiffness is an important measure of cardiovascular risk. Augmentation index (Al) is a reflection of arterial stiffness and can be determined by pulse wave analysis of the radial artery. Methods: 21 hypertensive liver transplant recipients were commenced on the calcium channel blocker amlodipine. 8 patients who were intolerant of or unresponsive to amlodipine were administered the beta-adrenoceptor antagonist bisoprolol and the angiotensin converting enzyme inhibitor lisinopril in a crossover study. Systolic blood pressure (BP) and Al were measured before and after a median of 10 weeks on each drug. Al is expressed as a percentage of the central pulse pressure. No patient received any additional antihypertensive therapy including diuretics. Results: Al fell from 24 ± 2% to 16 ± 2% (p < 0.001) with amlodipine while BP fell from 156 ± 2 to 133 ± 2 mm Hg (p < 0.001). Al increased from 17 ± 5% to 26 ± 3% (p = 0.015) with bisoprolol while BP fell from 158 ± 5 to 142 ± 3 mm Hg (p = 0.019). In contrast, lisinopril reduced Al From 20 ± 2% to 13 ± 3% (p = 0.021) and BP fell from 156 ± 2 to 133 ± 5 mm Hg (p = 0.003). 40% experienced lower limb oedema with amlodipine. Bisoprolol and lisinopril were both well tolerated. Creatinine clearance was unchanged after treatment with lisinopril. Discussion: Amlodipine reduces BP and Al but Iow doses are required in view of the frequency of leg oedema. The choice of bisoprolol or lisinopril as second line treatment is influenced by the differing effects on augmentation index. The increase in Al with bisoprolol implies that central aortic pressure is not reduced as much as appears from the observed reduction in peripheral BP. Lisinopril, by reducing Al and arterial stiffness, may therefore be preferred to bisoprolol. The long term effects of these drugs upon...


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