Blood pressure medication for kidney transplant recipients

In some patient groups, different blood pressure lowering drugs have differing relative beneficial and harmful effects in addition to their blood pressure lowering action. We investigated whether different classes of drugs might have different relative effects in kidney transplant patients. We found that calcium channel blockers (CCB) reduced the risk of graft loss by about 25% in randomised studies, compared to placebo or no treatment. CCB also improved the function of grafts, as measured by glomerular filtration rate (GFR) with GFR 4.5 mL/min higher on average in patients receiving CCB compared to placebo. There were fewer studies comparing angiotensin converting enzyme inhibitors (ACEi) to placebo and their results were inconclusive. In studies that compared ACEi to CCB, ACEi worsened GFR by about 11.5 mL/min on average. ACEi also lowered haemoglobin and increased the risk of elevated blood potassium compared to CCB. There were not enough studies of other classes of drugs to draw conclusions about their relative effects. On current evidence CCB might therefore be the best agents for kidney transplant patients.