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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:
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