Effect of Angiotensin II Type-1 Receptor Blockers on Stable Allograft Kidneys: Prospective Randomized Study

Is assess the effects of angiotensin II type-I receptor blockers on outcomes in
renal transplant recipients without proteinuria or posttransplantation erythrocytosis.
Patients and Methods. Fifty renal transplant recipients (30 men and 20 women, with a
mean [SD] age of 40 [13] years) were randomized into 2 groups of 25 patients each; 1
group was treated with losartan for 1 year, and the other was not (control group). Blood
pressure and other biochemical parameters were measured at baseline and at 6 and 12
months posttransplantation.
Results. After 1 year, the losartan group had significantly lower systolic blood pressure
(113 [22] mm Hg vs 126 [18] mm Hg; P � .04) and hemoglobin concentration (12.8 [1.9]
g/dL vs 14.5 [2.1] g/dL; P � .006) and significantly higher serum high-density lipoprotein
cholesterol concentration (58 [22] mg/dL vs 47 [10] mg/dL; P � .03) compared with the
control group; however the incidence of anemia did not differ (37% vs 20%; P � .20). In
the losartan group, there were significant changes in hemoglobin concentration between
baseline and 6 months (14.5 [1.6] g/dL vs 12.9 [1.49] g/dL; P � .001), but not between 6 and
12 months (12.9 [1.49] g/dL vs 12.8 [1.96] g/dL; P � .43). After 1 year, there were no
significant between-group differences in diastolic hypertension, serum creatinine concentration,
creatinine clearance, and serum potassium, low-density lipoprotein cholesterol,
triglyceride, and uric acid concentrations.
Conclusion. Losartan significantly increased high-density lipoprotein concentration and
significantly decreased systolic hypertension. Although losartan decreased the hemoglobin
concentration during the first 6 months, its effect did not progress with longer use. To
determine the effect of losartan on renal function, additional studies with longer follow-up
are needed.