Candesartan improves blood pressure control and reduces proteinuria in renal transplant recipients: results from SECRET

被引:74
作者
Philipp, Thomas [1 ]
Martinez, Franck [2 ,3 ]
Geiger, Helmut [4 ]
Moulin, Bruno [5 ]
Mourad, Georges [6 ]
Schmieder, Roland [7 ]
Lievre, Michel [8 ]
Heemann, Uwe [9 ]
Legendre, Christophe [2 ,3 ]
机构
[1] Univ Klinikum Essen, Med Klin, Essen, Germany
[2] Univ Paris 05, Paris, France
[3] Hop Necker Enfants Malad, Paris, France
[4] Univ Frankfurt Klinikum, Med Klin Nephrol 3, D-6000 Frankfurt, Germany
[5] Hop Civil, Serv Nephrol Transplantat Renale, Strasbourg, France
[6] Hop Lapeyronie, Dept Nephrol & Transplantat, Montpellier, France
[7] Univ Erlangen Nurnberg, Dept Hypertens & Nephrol, Erlangen, Germany
[8] Univ Lyon 1, Serv Pharmacol Clin, UMR5558, F-69365 Lyon, France
[9] Tech Univ Munich, Klinikum Rechts Isar, Abt Nephrol 2, Med Klin & Poliklin, Munich, Germany
关键词
angiotensin II type 1 receptor blocker; blood pressure; candesartan; kidney transplantation; proteinuria; CONVERTING ENZYME-INHIBITION; RENIN-ANGIOTENSIN SYSTEM; KIDNEY-TRANSPLANTATION; GRAFT-SURVIVAL; BLOCKADE; LOSARTAN; PATIENT; HYPERTENSION; ASSOCIATION; PROGRESSION;
D O I
10.1093/ndt/gfp581
中图分类号
R3 [基础医学]; R4 [临床医学];
学科分类号
1001 ; 1002 ; 100602 ;
摘要
Methods. The Study on Evaluation of Candesartan Cilexetil after Renal Transplantation (SECRET) was an international multicentre, double-blind, randomized investigation of the angiotensin II type 1 receptor blocker (ARB) candesartan cilexetil versus placebo in renal allograft recipients originally designed to study 700 patients for 3 years. The candesartan dose was escalated from 4 to 16 mg daily, followed by addition of co-medication, if needed, with the aim of achieving a diastolic blood pressure (BP) < 85 mmHg. The primary efficacy variable was a composite of all-cause mortality, cardiovascular morbidity and graft failure. Results. SECRET was stopped prematurely as the primary event rate was much lower than expected. At that point, 502 patients were enrolled; 255 received candesartan and 247 placebo. Thirteen primary events had occurred in each group. Control of both systolic and diastolic BP was better in the candesartan group. Urinary protein excretion and protein/creatinine ratio decreased on candesartan but increased on placebo. Serum creatinine and potassium were increased in candesartan patients, but these changes were generally small. Conclusions. SECRET provides insights into the design and conduct of studies in this area and evidence for the utility of candesartan, which showed good safety and tolerability, improved BP control and decreased proteinuria in renal transplant recipients.
引用
收藏
页码:967 / 976
页数:10
相关论文
共 33 条
[1]   Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy [J].
Brenner, BM ;
Cooper, ME ;
de Zeeuw, D ;
Keane, WF ;
Mitch, WE ;
Parving, HH ;
Remuzzi, G ;
Snapinn, SM ;
Zhang, ZX ;
Shahinfar, S .
NEW ENGLAND JOURNAL OF MEDICINE, 2001, 345 (12) :861-869
[2]   Long-term anti-proteinuric effect of Losartan in renal transplant recipients treated for hypertension [J].
Calviño, J ;
Lens, XM ;
Romero, R ;
Sánchez-Guisande, D .
NEPHROLOGY DIALYSIS TRANSPLANTATION, 2000, 15 (01) :82-86
[3]   Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure [J].
Chobanian, AV ;
Bakris, GL ;
Black, HR ;
Cushman, WC ;
Green, LA ;
Izzo, JL ;
Jones, DW ;
Materson, BJ ;
Oparil, S ;
Wright, JT ;
Roccella, EJ .
HYPERTENSION, 2003, 42 (06) :1206-1252
[4]   PREDICTION OF CREATININE CLEARANCE FROM SERUM CREATININE [J].
COCKCROFT, DW ;
GAULT, MH .
NEPHRON, 1976, 16 (01) :31-41
[5]   Efficacy and safety of losartan in the treatment of hypertension in renal transplant recipients [J].
Del Castillo, D ;
Campistol, JM ;
Guirado, L ;
Capdevilla, L ;
Martínez, JG ;
Pereira, P ;
Bravo, J ;
Pérez, R .
KIDNEY INTERNATIONAL, 1998, 54 :S135-S139
[6]  
Fogo AB, 2001, J NEPHROL, V14, P567
[7]   Influence of AT1 receptor blockade on blood pressure, renal haemodynamics and hormonal responses to intravenous angiotensin II infusion in hypertensive patients [J].
Fridman, KUB ;
Elmfeldt, D ;
Wysocki, M ;
Friberg, PR ;
Andersson, OK .
BLOOD PRESSURE, 2002, 11 (04) :244-252
[8]  
Gradman A H, 1999, Heart Dis, V1, P52
[9]   Angiotensin-converting enzyme inhibitor or angiotensin II type 1 receptor antagonist therapy is associated with prolonged patient and graft survival after renal transplantation [J].
Heinze, Georg ;
Mitterbauer, Christa ;
Regele, Heinz ;
Kramar, Reinhard ;
Winkelmayer, Wolfgang C. ;
Curhan, Gary C. ;
Oberbauer, Rainer .
JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY, 2006, 17 (03) :889-899
[10]   Renin angiotensin system blockade in kidney transplantation: A systematic review of the evidence [J].
Hiremath, S. ;
Fergusson, D. ;
Doucette, S. ;
Mulay, A. V. ;
Knoll, G. A. .
AMERICAN JOURNAL OF TRANSPLANTATION, 2007, 7 (10) :2350-2360