Howard R L, Shapiro J I, Babcock S, Chan L
Department of Medicine, University of Colorado School of Medicine, Denver 80262.
Ren Fail. 1990;12(2):89-92. doi: 10.3109/08860229009087123.
Thirteen patients found to be hypertensive following renal transplantation were treated with either a calcium channel blocker or other antihypertensive therapy for control of blood pressure. Immunosuppression was either with cyclosporine and prednisone alone or with cyclosporine, azathioprine, and prednisone. Patients had weekly or biweekly cyclosporine whole-blood levels measured by radioimmunoassay drawn approximately 12 h after their last dose. Patients treated with cyclosporine and prednisone alone had their cyclosporine dosage adjusted to maintain their cyclosporine level between 400 and 900 ng/mL between 1 and 6 months following transplantation. Patients treated with cyclosporine, azathioprine, and prednisone had their cyclosporine level adjusted to be between 100 and 400 ng/mL during this same time period. Cyclosporine levels were significantly higher in verapamil-treated patients and significantly lower in nifedipine-treated patients as compared to controls. The dose of cyclosporine administered was significantly lower in the verapamil-treated patients and higher in the nifedipine-treated patients than controls. Normalizing the whole-blood cyclosporine level for the dose of cyclosporine, and verapamil-treated patients had a significantly greater, and the nifedipine-treated patients a significantly lower value than control patients. These data suggest the verapamil treatment results in significantly higher levels of cyclosporine whereas nifedipine therapy may actually result in lower cyclosporine levels for a given dose of cyclosporine than seen in patients not exposed to these drugs.
13例肾移植后出现高血压的患者接受了钙通道阻滞剂或其他抗高血压治疗以控制血压。免疫抑制方案为单独使用环孢素和泼尼松，或使用环孢素、硫唑嘌呤和泼尼松。患者在最后一剂药物服用约12小时后通过放射免疫分析法每周或每两周测量一次环孢素全血水平。单独接受环孢素和泼尼松治疗的患者在移植后1至6个月期间调整环孢素剂量，以使其环孢素水平维持在400至900 ng/mL之间。接受环孢素、硫唑嘌呤和泼尼松治疗的患者在同一时期将其环孢素水平调整为100至400 ng/mL。与对照组相比，维拉帕米治疗的患者环孢素水平显著更高，硝苯地平治疗的患者环孢素水平显著更低。维拉帕米治疗的患者给予的环孢素剂量显著低于对照组，而硝苯地平治疗的患者给予的环孢素剂量高于对照组。将全血环孢素水平按环孢素剂量进行标准化后，维拉帕米治疗的患者的值显著高于对照组，而硝苯地平治疗的患者的值显著低于对照组。这些数据表明，维拉帕米治疗可导致环孢素水平显著升高，而硝苯地平治疗对于给定剂量的环孢素而言，实际上可能导致比未使用这些药物的患者更低的环孢素水平。
