Influence of cyclosporine on posttransplant blood pressure response

The suggestion that hypertension is more prevalent in renal allograft recipients receiving cyclosporine (CyA), particularly those displaying nephrotoxicity, was tested by reviewing 200 patients' courses, including 92 cadaver (CAD) and 58 living-related (LRD) transplants using CyA and prednisone immunosuppression, and 19 CAD and 31 LRD transplants using azathioprine (Aza) and prednisone, all of whom had at least 1 year posttransplant complete outpatient follow-up. Both groups had a mean age of 33 years with a similar distribution of renal failure etiologies. Renal function was significantly impaired in the CyA group at all intervals (P less than .001, t test). The prevalence of hypertension was higher in the CyA group at all intervals, becoming significant at 12 (P less than .01) and 24 (P less than .05) months following transplantation (chi 2). While there was only a significant difference in mean diastolic BP at 12 months (P less than .05, t test), the mean number of antihypertensive and/or diuretic medications was significantly greater in the CyA group at 1 and 6 months (P less than .001) and at 12 months (P less than .01). By 24 months, the mean number of all antihypertensive and/or diuretic medications was no longer significantly different. However, the antihypertensive and diuretic requirements of the CyA group diminished with time, suggesting that the hypertension is not progressive if the CyA serum trough levels are maintained in the nontoxic range (less than 200 ng/mL).