A randomised cross-over study comparing the effectiveness of bisoprolol and lisinopril in controlling hypertension after liver transplantation

INTERVENTION: Hypertension is common after liver transplantation and in Cambridge occurs in approximately 75% of patients. Treatment generally involves more than one drug but there have not been any studies comparing different antihypertensive medication. Thus optimal treatment of hypertension is not known. A cross‐over study is planned to compare bisoprolol with lisinopril in patients with sustained hypertension after transplantation. Our current practice is to commence patients on amlodipine for hypertension. If this fails to control blood pressure then the dose is increased and patients are also commenced on a statin drug such as cerivastatin. Patients whose blood pressure is not controlled with amlodipine will then be randomised to receive either bisoprolol or lisinopril for 3 months, after which those taking bisoprolol will change to lisinopril and vice versa for a further 3 months. At this point the study ceases and the two treatments will be compared. Patients will be reviewed monthly in clinic to assess response to treatment and to allow for dosage adjustment where necessary. Measurements of plasma renin and arterial stiffness, using an ultrasound machine, will be collected during the study. CONDITION: Cardiovascular: Hypertension ; Circulatory System ; Secondary hypertension PRIMARY OUTCOME: Not provided at time of registration SECONDARY OUTCOME: Not provided at time of registration INCLUSION CRITERIA: 40 Patients over 18 undergoing outpatient follow‐up and having persisting hypertension.