Steigerwalt S P, Brar N, Dhungel A, Butcher D, Steigerwalt S, El-Ghouroury M, Provenzano R
Department of Nephrology, St. John Hospital and Medical Center, 18000 E Warren, Detroit MI 48224, USA.
Transplant Proc. 2009 Dec;41(10):4184-7. doi: 10.1016/j.transproceed.2009.07.109.
Calcineurin inhibitors (CNI) have brought dramatic improvements in early renal allograft survival. However, CNI are associated with posttransplant hypertension (PTHTN), a risk factor for mortality from cardiovascular disease and graft failure. Sirolimus (SRL) is emerging as an alternative to CNI. SRL effects on blood pressure (BP) in humans are unclear. We compared the prevalence of PTHTN among patients receiving SRL as maintenance immunosuppression with a group receiving CNI by using 24-hour ambulatory BP (AMBP). AMBP has been shown to predict cardiovascular events and progression of kidney disease better than casual office BP measurements in chronic kidney disease (CKD) patients.
Renal transplant recipients with office hypertension (defined as BP > 130/80 or on antihypertensive medications), receiving stable immunosuppression and displaying consistent serum creatinine values for > or =6 months were eligible. We enrolled the first 40 patients to consent. Office BP was measured twice using a BP-Tru machine. AMBP was then analyzed for systolic BP (SBP), diastolic BP (DBP), and nocturnal blood pressure fall (NF; "dipping"). Patients were placed in the SRL group (n = 18) and the CNI group (n = 20) based on their maintenance immunosuppressive protocol. Two patients were excluded because of incomplete data. All patients received mycophenolate mofetil, and 14/38, maintenance steroids. We collected, demographics as well as type and date of renal allograft, medications, comorbidities, CKD stage, proteinuria, and plasma creatinine at the time of study enrollment.
Patients in the SRL group displayed lower 24-hour SBP than the CNI group (128.0 +/- 10.8 vs 137.7 +/- 14; P = .029). Nightime MAP, nightime SBP, and nighttime DBP were all lower in the SRL group. NF did not reach significance between the SRL and CNI groups (44% vs 15%; P = .074). Patient demographics and number of antihypertensive medications did not differ.
The lower 24-hour SBP seen in the SRL group by AMBP may lead to improved cardiovascular and renal outcomes over time. Long-term patient follow-up will be needed to clarify the effect of the lower 24-hour SBP.
钙调神经磷酸酶抑制剂（CNI）显著提高了肾移植早期的存活率。然而，CNI与移植后高血压（PTHTN）相关，PTHTN是心血管疾病死亡和移植失败的危险因素。西罗莫司（SRL）正逐渐成为CNI的替代药物。SRL对人体血压（BP）的影响尚不清楚。我们通过24小时动态血压监测（AMBP）比较了接受SRL维持免疫抑制治疗的患者与接受CNI治疗的患者中PTHTN的患病率。在慢性肾脏病（CKD）患者中，AMBP已被证明比常规诊室血压测量更能预测心血管事件和肾脏疾病进展。
符合条件的肾移植受者为患有诊室高血压（定义为血压>130/80或正在服用抗高血压药物）、接受稳定免疫抑制治疗且血清肌酐值持续≥6个月稳定的患者。我们招募了前40名同意参与的患者。使用BP-Tru机器测量两次诊室血压。然后分析AMBP的收缩压（SBP）、舒张压（DBP）和夜间血压下降（NF；“勺型”）情况。根据维持免疫抑制方案将患者分为SRL组（n = 18）和CNI组（n = 20）。两名患者因数据不完整被排除。所有患者均接受霉酚酸酯治疗，14/38名患者接受维持性类固醇治疗。我们收集了研究入组时的人口统计学资料以及肾移植的类型和日期、药物、合并症、CKD分期、蛋白尿和血浆肌酐水平。
SRL组患者的24小时SBP低于CNI组（128.0±10.8 vs 137.7±14；P = 0.029）。SRL组的夜间平均动脉压、夜间SBP和夜间DBP均较低。SRL组与CNI组之间的NF无显著差异（44% vs 15%；P = 0.074）。患者的人口统计学资料和抗高血压药物数量无差异。
通过AMBP观察到SRL组较低的24小时SBP可能会随着时间推移改善心血管和肾脏结局。需要对患者进行长期随访以明确较低的24小时SBP的影响。
