Curtis J J, Luke R G, Jones P, Diethelm A G
Department of Medicine, University of Alabama Medical Center, Birmingham 35294.
Am J Med. 1988 Aug;85(2):134-8. doi: 10.1016/s0002-9343(88)80331-0.
Physicians increasingly prescribe cyclosporine as an immunosuppressive agent for both organ-transplant and non-organ-transplant recipients. Investigators have reported a high incidence of drug-induced hypertension even when clinical nephrotoxicity was not present. We wanted to determine the reason.
A comparison was made of hypertension in 15 cyclosporine-treated transplant recipients with that in a similar group of 15 azathioprine-treated transplant recipients.
Hypertension in the cyclosporine group responded differently from that seen in the azathioprine group and from previously described forms of post-transplantation hypertension. Hypertensive cyclosporine-treated patients show a sodium acquisitive renal state that responds to sodium restriction. Unlike rat models, which suggest cyclosporine-induced stimulation of the renin-angiotensin system, or previous forms of post-transplant hypertension in humans, plasma renin levels were not elevated and blood pressure did not respond to a test dose of captopril.
Hypertension in cyclosporine-treated patients is an iatrogenic form of hypertension that may be associated with an early, subtle, renal defect in sodium excretion, a genesis of hypertension that is consistent with Guyton's view of essential hypertension.
医生越来越多地将环孢素作为免疫抑制剂用于器官移植和非器官移植受者。研究人员报告称，即使不存在临床肾毒性，药物性高血压的发生率也很高。我们想确定其原因。
对15名接受环孢素治疗的移植受者的高血压情况与15名接受硫唑嘌呤治疗的类似移植受者组进行了比较。
环孢素组的高血压与硫唑嘌呤组以及先前描述的移植后高血压形式的反应不同。接受环孢素治疗的高血压患者表现出一种对钠限制有反应的钠摄取性肾脏状态。与提示环孢素诱导肾素-血管紧张素系统刺激的大鼠模型或人类先前的移植后高血压形式不同，血浆肾素水平未升高，血压对卡托普利试验剂量无反应。
接受环孢素治疗患者的高血压是一种医源性高血压形式，可能与早期、细微的肾钠排泄缺陷有关，这种高血压的发生与盖顿关于原发性高血压的观点一致。
