Loss of nocturnal blood pressure fall after liver transplantation during immunosuppressive therapy*

Abstract

Hypertension, which develops after organ transplantation during immunosuppression with cyclosporine (CSA), is often associated with a loss of nocturnal decrease in blood pressure. Few data correlate circadian blood pressure patterns before transplant with those observed at fixed time points after transplant, or address the role of alternate immunosuppressive agents such as FK506. FK506 is unrelated structurally to CSA and less often leads to hypertension early after transplant. The present study compared nocturnal blood pressure patterns in patients with end-stage liver disease (ESLD) before transplant to those of transplant recipients receiving either FK506 (0.15 mg/kg/day) plus prednisone or CSA (2 to 3 mg/kg/day) plus prednisone and azathioprine after orthotopic liver transplantation. Overnight ambulatory blood pressure profiles were studied in 13 pretransplant ESLD patients and in 34 patients (FK506: n = 13; CSA: n = 21) treated with different steroid doses (24 +/- 11 mg/day FK506; 34 +/- 3 mg/day CSA), according to protocol, 4 weeks (range, 2 to 7 weeks) after liver transplant. Mean blood pressure and heart rate values from awake and nocturnal 5-h time blocks were compared to 13 normotensive control subjects. Patients with ESLD were normotensive and maintained a normal nocturnal blood pressure fall (125 +/- 3/74 +/- 2 mm Hg awake; 109 +/- 3/60 +/- 2 mm Hg nocturnal). Awake ambulatory blood pressures were higher in CSA patients than in FK506 patients (148 +/- 3/95 +/- 2 v 128 +/- 3/78 +/- 2 mm Hg, respectively; P < .01), despite reduced glomerular filtration rates in both transplant groups. Both immunosuppressive regimens led to a loss of nocturnal blood pressure fall, as compared to ESLD patients or normotensive controls.(ABSTRACT TRUNCATED AT 250 WORDS)

Association of Kidney Function and Metabolic Risk Factors With Density of Glomeruli on Renal Biopsy Samples From Living Donors

“…The mean overall blood pressure, mean active blood pressure (4 pm to 9 pm), and mean nocturnal blood pressure (12 am to 5 am) were obtained. 20,21 Hypertension was defined by treatment with antihypertensive therapy. Family history of end-stage renal disease (ESRD) was defined by the recipient being related to the donor.…”

Blood Pressure Evaluation among Older Living Kidney Donors

“…These measurements were obtained during quiet sitting at a recording station. An overnight automated ABPM monitor (Spacelabs, Issaquah, WA) was then placed for 18 h for analysis of 5-h blocks of "awake" and "inactive" BP values, as described previously (13). Circadian rhythm (day/night difference) was determined as the average awake readings minus the average inactive readings recorded during continuous 5-h periods.…”

European Society of Hypertension guidelines for blood pressure monitoring at home: a summary report of the Second International Consensus Conference on Home Blood Pressure Monitoring

“…This is a common finding also in patients undergoing haemodialysis and continuous ambulatory peritoneal dialysis [154,155] and after renal transplantation [156][157][158]. In addition to the renal disease itself, frequently used drugs in these patients (erythropoietin [159] and cyclosporine [160]) also contribute to an increase in the prevalence and severity of hypertension.…”