title: Mechanisms of hypertension in cardiac transplantation and the role of cyclosporine.
abstract: The use of cyclosporine in solid organ transplantation has been shown to be associated with the development of hypertension and nephrotoxicity. Several mechanisms, including endothelin-mediated systemic vasoconstriction, impaired vasodilatation secondary to reduction in nitric oxide, and altered cytosolic calcium translocation, have been proposed to underlie cyclosporine-induced hypertension. In addition, other studies have shown activation of the sympathetic nervous system and the renin-angiotensin system, as well as abnormalities in prostaglandin metabolism, as culpable mechanisms. Hemodynamic features of cyclosporine-induced hypertension consist of elevated peripheral vascular resistance, ventricular vascular uncoupling contributing to left ventricular hypertrophy, and abnormalities in the diastolic function of the allograft. Combined calcium-channel blockers and angiotensin-converting enzyme inhibitors have been used for this treatment of this clinical problem, and they achieve blood pressure control in 65% of patients. Moreover, these agents may also be beneficial in preventing development of cardiac allograft vasculopathy, a long-term nemesis in cardiac transplantation.
authors.affiliation: Ochsner Medical Institutions, New Orleans, LA 70121, USA.
authors.forename: H O
authors.initials: HO
authors.lastname: Ventura
authors.forename: F S
authors.initials: FS
authors.lastname: Malik
authors.forename: M R
authors.initials: MR
authors.lastname: Mehra
authors.forename: D D
authors.initials: DD
authors.lastname: Stapleton
authors.forename: F W
authors.initials: FW
authors.lastname: Smart
mesh_terms: D000818:Animals; D016572:Cyclosporine / Q000009:adverse effects*; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D006973:Hypertension / Q000139:chemically induced* / Q000209:etiology* / Q000503:physiopathology
chemical_list: D016572:Cyclosporine