Mechanism of Hypertension Treatments in Liver Transplant Recipients (BLOCK LTR-HTN)

• Status: Recruiting
• Trial end date: 2025-06-01
• Target enrollment: 0
• Participant gender: All

Summary

Liver transplantation is a high risk, high-cost intervention that extends life in over 8,000 patients in the US each year. Of those that receive transplants, 1 in 3 will have a complication related to their heart after transplant. Research has been done to attempt to reduce the risk of these complications from occurring. High blood pressure, otherwise known as "hypertension," is an important risk factor for heart complications. Hypertension is found in 92% of liver transplant recipients within 6 years of their procedure. However, using data from our transplant patients at Northwestern we recently showed that having a normal blood pressure in the first year following liver transplant lowered the risk of heart complications and the risk of death by over half. However, there are no studies investigating the best medications to lower blood pressure in liver transplant recipients.

There are several types of medications that can be used to treat high blood pressure. Currently, most transplant providers use a class of medications called calcium channel blockers as the first medications for hypertension in liver transplant patients. However, there is little data to support this recommendation. There is some new evidence suggesting that another class of medications, called thiazide-like diuretics, might be beneficial to lower blood pressure in liver transplant recipients. The current study will use two different medications: the calcium channel blocker called amlodipine besylate (at dose of 10mg) and the thiazide-like diuretic known as chlorthalidone (25mg). Both medications are taken once per day by mouth and are FDA approved for the treatment of high blood pressure in the general population.

The main purpose of this study is to determine how well these two medications lower blood pressure and how they may improve markers of heart function and kidney function in liver transplant recipients. The long-term goal of this research is to improve heart outcomes in those that have undergone liver transplant by addressing risk factors that can be modified, including blood pressure. This study will help determine the size of the needed group for further studies to ensure proper investigation of which of these two medications may most benefit liver transplant patients.

• Phase: Phase 4
• Accepts Healthy Volunteers?: No

Details

• Lead Sponsor: Northwestern University
• Collaborators: American Society for Transplantation; National Heart, Lung, and Blood Institute (NHLBI)
• Treatments: Amlodipine; Chlorthalidone

Criteria

Inclusion Criteria:

• Liver transplant alone recipient

• At least 90 days from transplant

• Average daytime systolic blood pressure (SBP)>140mmHG with 24h ambulatory blood pressure monitoring.

patients will be enrolled in 24h ambulatory blood pressure monitoring (ABPM) if they have hypertension (HTN) defined by diagnostic codes, treatment with antihypertensive medications for ≥ 2 months, and a history of office blood pressure readings ≥140/90 mmHg at two separate office visits.

• Stable medical therapy (e.g., no change in current antihypertensive medications or immunosuppression for ≥ 30d)

Exclusion Criteria:

• Contraindication to withholding calcium channel blockers (CCB) or beta-blocker (e.g., atrial fibrillation/flutter)

• Treatment with other diuretics that cannot be held

• Acute coronary syndrome or revascularization within 60d

• Serum potassium < 4.0 mEq/L

• Serum sodium < 135 mg/dL

• Allergy to sulfa drugs

• Steroid use > 5 mg/d

• Estimated Glomerular Filtration Rate (eGFR) < 30 mL/min/1.73 m2 or on dialysis

• Pregnant women