Antihypertensives for kidney transplant recipients: Systematic review and meta-analysis of randomized controlled trials

Nicholas L. Cross, Angela C. Webster, Philip Masson, Philip J. O'Connell, Jonathan C. Craig

Research output: Contribution to journalReview articlepeer-review

84 Citations (Scopus)


In some nontransplant populations, effects of different antihypertensive drug classes vary. Relative effects in kidney transplant recipients are uncertain.
To assess comparative effects of different classes of antihypertensive agents in kidney transplant recipients.
Search methods
MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, conference proceedings and reference lists of identified studies were searched.
Selection criteria
Randomised controlled trials of any antihypertensive agent applied to kidney transplant recipients for at least two weeks were included.
Data collection and analysis
Data was extracted by two investigators independently. Study quality, transplant outcomes and other patient centred outcomes were assessed using random effects meta‐analysis. Risk ratios (RR) for dichotomous outcomes and mean difference (MD) for continuous outcomes, both with 95% confidence intervals (CI) were calculated. Stratified analyses and meta‐regression were used to investigate heterogeneity.
Main results
We identified 60 studies, enrolling 3802 recipients. Twenty‐nine studies (2262 participants) compared calcium channel blockers (CCB) to placebo/no treatment, 10 studies (445 participants) compared angiotensin converting enzyme inhibitors (ACEi) to placebo/no treatment and seven studies (405 participants) compared CCB to ACEi. CCB compared to placebo/no treatment (plus additional agents in either arm as required) reduced graft loss (RR 0.75, 95% CI 0.57 to 0.99) and improved glomerular filtration rate (GFR), (MD, 4.45 mL/min, 95% CI 2.22 to 6.68). Data on ACEi versus placebo/no treatment were inconclusive for GFR (MD ‐8.07 mL/min, 95% CI ‐18.57 to 2.43), and variable for graft loss, precluding meta‐analysis. In direct comparison with CCB, ACEi decreased GFR (MD ‐11.48 mL/min, 95% CI ‐5.75 to ‐7.21), proteinuria (MD ‐0.28 g/24 h, 95% CI ‐0.47 to ‐0.10), haemoglobin (MD ‐12.96 g/L, 95% CI ‐5.72 to ‐10.21) and increased hyperkalaemia (RR 3.74, 95% CI 1.89 to 7.43). Graft loss data were inconclusive (RR 7.37, 95% CI 0.39 to 140.35). Other drug comparisons were compared in small numbers of participants and studies.
Authors' conclusions
These data suggest that CCB may be preferred as first line agents for hypertensive kidney transplant recipients. ACEi have some detrimental effects in kidney transplant recipients. More high quality studies reporting patient centred outcomes are required.
Original languageEnglish
Pages (from-to)7-18
Number of pages12
Issue number1
Publication statusPublished - 15 Jul 2009
Externally publishedYes


  • Meta-analysis
  • Review
  • Kidney transplantation
  • Antihypertensive agents


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