Hemodynamic effects of amlodipine, bisoprolol, and lisinopril in hypertensive patients after liver transplantation1

Abstract

BACKGROUND: Hypertension is common after liver transplantation. There are few published data on optimum treatment. Augmentation index (AIx) is a measure of arterial wave reflection determined by pulse wave analysis. METHODS: Amlodipine was administered to 24 hypertensive liver transplant recipients. Thirteen patients intolerant of or unresponsive to amlodipine were randomized to a crossover study comparing bisoprolol with lisinopril. RESULTS: With amlodipine, systolic blood pressure (SBP) fell from 154+/-2 mm Hg to 130+/-2 mm Hg, and AIx also fell. With bisoprolol, SBP fell from 154+/-2 mm Hg to 142+/-4 mm Hg, but AIx increased. With lisinopril, SBP fell from 154+/-2 mm Hg to 130+/-5 mm Hg, and AIx also fell (P <0.001 throughout). CONCLUSIONS: Amlodipine is an effective treatment for hypertension. The increased AIx with bisoprolol indicates increased wave reflection such that central aortic pressure is reduced less than peripheral SBP. Lisinopril reduces AIx and reduces SBP more than bisoprolol and is the preferred drug.