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Article Review/Hyperlink
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van den Dorpel MA, van den Meiracker AH, Lameris TW, Boomsms
F, Levi M, et al
Cyclosporin A impairs the nocturnal blood pressure fall
in renal transplant recipients
Hypertens
(Aug) 28:304-307 1996

The world according to students of ambulatory blood pressure
monitoring could be described as having two populations: The Dippers
and the Non-Dippers. The lack of a normal nocturnal decline in blood
pressure has been correlated in a number of studies with the
development of left ventricular hypertrophy and has been associated
with an increased risk for cardiovascular complications in patients with
hypertension.
This study examined blood pressure patterns in 18 renal
transplant patients already enrolled in another study of
immunosuppressive management strategies who were on cyclosporin
and then restudied their blood pressure curves after 16 weeks of
azathioprine treatment while on a constant dose of steroids. All
antihypertensives were discontinued 3 days before the study. Diabetics
were excluded for unclear reasons. Cyclosporin levels were relatively
similar at 250 +/- 66 mg/L but the number of patients on once versus
twice daily dosing schedules was not provided and may have
implications on peak nighttime concentrations hence effects.
A significantly higher mean nighttime blood pressure with smaller dip was
noted with cyclosporin (117 mm Hg with a fall of 4 mm Hg) when
compared to the azathioprine period (109 mm Hg with a fall of 9 mm Hg).
While levels of norepinephrine and renin did not change between the two
drugs, prostaglandin E2 as well as thromboxane B2 and plasma atrial
natriuretic peptide fell slightly. The authors suggest therefore that
cyclosporin may have a greater effect on blood pressure aberrations by
a volume dependant mechanism than previously thought. The complex
interactions on the sympathetic nervous system are felt by others to be
the dominant factor. In any case, this data raises one more concern
regarding cyclosporin, the golden shield of acute rejection, and its
adverse effect on long term cardiovascular morbidity and mortality.
(Sri Narsipur MD, SUNY-HSC at Syracuse, NY)
The full text of this abstract is available from the AHA at:
this site
.
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