Arterial hypertension in heart transplant recipients treated with triple-drug immunosuppressive therapy.
Arterial hypertension occurs in the majority of heart transplant recipients treated with high dosages of cyclosporine. The incidence of hypertension with lower loading and maintenance dosages of cyclosporine, as used with triple-drug immunosuppressive therapy is unknown. Fifty-six patients who had transplantation at the University of Minnesota, Minneapolis, from December 1983 through December 1986, received low loading (6 to 10 mg/kg) and maintenance dosages of cyclosporine in addition to azathioprine (2 to 2.5 mg/kg/day) and prednisone. Two weeks after transplantation 68% of the patients were hypertensive (blood pressure greater than 140/90 mm Hg) despite normal serum creatinine levels (1.14 +/- 0.33 mg/dl). The number of patients requiring treatment for hypertension increased progressively, with 92% of the patients being hypertensive by 6 months. No correlation was found between blood pressure values, serum creatinine levels, and cyclosporine levels in the blood. Systemic vascular resistances were elevated 1 year after transplantation, whereas cardiac output and ventricular filling pressures were normal. Circulating norepinephrine levels, abnormally elevated before transplantation, normalized after operation. In 13 heart recipients in whom sequential measurements were obtained, plasma norepinephrine levels decreased within 2 weeks after transplantation. These data indicated that hypertension develops in almost all patients after heart transplantation despite the lower dosage of cyclosporine used with the triple-drug immunosuppressive therapy and the absence of significant renal impairment with this regimen, and probably it is not the result of activation of the sympathetic nervous system.
Olivari
M T
MT
Department of Medicine and Surgery, University of Minnesota Medical School, Minneapolis.
Antolick
A
A
Ring
W S
WS
D000328:Adult; D001379:Azathioprine / Q000008:administration & dosage*; D001794:Blood Pressure / Q000187:drug effects; D003404:Creatinine / Q000097:blood; D003524:Cyclosporins / Q000008:administration & dosage / Q000009:adverse effects*; D004359:Drug Therapy, Combination; D005260:Female; D016027:Heart Transplantation; D006801:Humans; D006973:Hypertension / Q000139:chemically induced*; D007165:Immunosuppression Therapy / Q000009:adverse effects*; D007668:Kidney / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000097:blood; D011241:Prednisone / Q000008:administration & dosage*; D013564:Sympathetic Nervous System / Q000187:drug effects; D014655:Vascular Resistance / Q000187:drug effects
D003524:Cyclosporins; D003404:Creatinine; D001379:Azathioprine; D011241:Prednisone; D009638:Norepinephrine