Hypertension: The Neglected Complication of Transplantation

Table 1

Drugs used for the treatment of calcineurin inhibitor-induced arterial hypertension.

Class of Drug	Name	Characteristics	Adverse effects	Interaction with Cyclosporine (CyC)
Calcium Channel Blockers
	Nifedipine	Counteract CyC (and possibly TAC) induced vasoconstriction	Edema, Headache, tachycardia, erythema, gingival hyperplasia	− −
	Isradipine	Idem	Idem	− −
Dihydropyridines	Felodipine	Idem	Idem	− −
	Amlodipine	Idem	Idem	±
	Nicardipine	Idem	Idem	++
	Lercanidipine	Idem	Less edema	±
Nondihydropyridines	Diltiazem HCL	Moderate power, reduces coronary vasculopathy after heart transplant	Edema, headache	++
	Verapamil HCL	Less vasodilatory power, potentiates immunosuppression?	Constipation, bradycardia, AV block	++
Beta Blockers	Atenolol; Bisoprolol; Metoprolol	May reduce Cyc-induced headache; Useful when concomitant cardiac disease is present	Bradycardia, bronchospasm	− −
	Nebivolol	Idem + Nitric Oxide release vasodilation
Alpha-beta blockers	Labetalol	Effective oral and intravenous administration	Bradycardia, Orthostatic hypotension	− −
	Carvedilol	Extended release formulation allow once daily use	Bradycardia, bronchospasm	− −
	Enalapril	Limited efficacy with once daily use	Hyperkalemia, Hyperazotemia Nongap Metabolic Acidosis; Dry Cough	− −
ACE Inhibitors	Lisinopril	Effective along with diuretics may limit renal fibrosis	Idem	− −
	Perindopril; Zofenopril	Idem + allow once daily use	Idem
Thiazide or Thiazide—like diuretics	Hydrochlorothiazide; Indapamide	Counteract sodium retention, potentiate other anti-AH drugs	Prerenal azotemia, Hyperuricemia; Hypokalemia; Hyponatremia	− −
	Chlortalidone	Idem + better 24-h profile, lowers nocturnal BP	Idem
Loop Diuretics	Furosemide	Strong, short action	Hypokalemia, hypomagnesemia	− −
	Torasemide	Sustained action	Idem	− −
	Minoxidil	K-channel opener. Use with loop diuretics and BBs to minimize adverse effects	Pericardial effusion, Tamponade,; Angina pectoris	− −
Centrally acting vasodilators	Clonidine	Alpha-2 adrenergic and imidazoline-1 receptor agonist	Sedation, dry mouth	− −
	Moxonidine	Imidazoline type 1 receptor agonist. Promotes natriuresis	Sedation, dry mouth.	− −