Doxazosin GITS trough to peak ratio and 24-hour blood pressure monitoring in the management of hypertension in renal transplant patients

• Published in: Transplantation proceedings Vol. 35; no. 5; pp. 1736 - 1738
• Main Authors: Martínez Castelao, A, Ibernón, M, Sarrias, X, Sanz, V, Moreso, F, Rama, I, Grinyó, J.M
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York, NY Elsevier Inc 01-08-2003; Elsevier Science
• Subjects: Antihypertensive Agents - pharmacokinetics; Antihypertensive Agents - therapeutic use; Biological and medical sciences; Blood Pressure - drug effects; Blood Pressure Monitoring, Ambulatory - methods; Doxazosin - pharmacokinetics; Doxazosin - therapeutic use; Female; Humans; Hypertension - drug therapy; Kidney Transplantation - physiology; Male; Medical sciences; Middle Aged; Postoperative Complications - drug therapy; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Human; Hypertension; Doxazosin; Hour; α1-Adrenergic receptor; Cardiovascular disease; Transplantation; Time response relation; Management; Homotransplantation; Kidney; Therapeutic drug monitoring; Chemotherapy; Alpha blocking agent; Clinical management; Treatment; Surveillance; Surgery; Graft; Arterial pressure; Blood pressure; Ratio; Hemodynamics; Antagonist
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/S0041-1345(03)00731-0

We have studied 20 patients, 10 male, 10 female, mean age 52.5 ± 10.9 years, who received a cadaver kidney transplant between June 1996 and January 1999. The patients presented with mild or moderate high BP and were treated on a maintained immunosuppression with an anti-calcineurin agent and steroids, associated or not to mycophenolate-mofetil.
At baseline, a 24-hour ambulatory BP monitoring was performed. General biochemical parameters were determined and doxazosin GITS (Gastro-Intestinal Therapeutic System) in a single dose of 4 mg/d was started. Doxazosin GITS was titrated four weeks after up to 8 mg/d if the BP was greater than 140/90 mm Hg. At week 12, biochemical analysis were repeated as well as the 24-hour BP monitoring and the T/P ratio was calculated.
The patients were divided in responders, T/P index > 50%,
n = 10 or not-responders, T/P index < 50%,
n = 10 patients). No differences in systolic BP (SBP), diastolic BP(DBP), plasma creatinine or proteinuria were seen at base-line. DBP was lower in responders than in non-responders (
P = ns). Doxazosin doses were 5.5 ± 3 mg/d vs 5.8 ± 3 and T/P ratio 0.70 ± 0.13 vs 0.17 ± 0.14, (
P = .001). There were no variations in pl. t. cholesterol, triglycerides, glucose or uric acid.
treatment was safe and efficient, not increasing metabolic adverse effects. Doxazosin GITS is a safe agent which can reduce cardiovascular risk. In our patients, the good T/P ratio has been associated with a best diastolic BP control. This good profile should be taken into account for 24-hour BP control in hypertensive renal transplant patients.