van den Dorpel M A, van den Meiracker A H, Lameris T W, Boomsma F, Levi M, Man in 't Veld A J, Weimar W, Schalekamp M A
Department of Internal Medicine I, University Hospital Dijkzigt, Rotterdam, Netherlands.
Hypertension. 1996 Aug;28(2):304-7. doi: 10.1161/01.hyp.28.2.304.
In renal transplant recipients, hypertension and a diminished nocturnal blood pressure fall are frequently found. To investigate whether this diminished nocturnal blood pressure fall is related to the use of cyclosporin A or to other factors, such as the use of glucocorticoids, we measured 24-hour ambulatory blood pressure in 18 renal transplant recipients both before and 16 weeks after conversion from cyclosporin A to azathioprine. Renal blood flow and glomerular filtration rate were estimated from 131I-hippurate and 125I-iothalamate clearances, respectively, and plasma concentrations of renin, atrial natriuretic peptide, norepinephrine, prostaglandin E2, and thromboxane B2 were determined. During cyclosporin A treatment, mean 24-hour blood pressure was 117 +/- 3 mm Hg, and the nocturnal fall in blood pressure was 4 +/- 9 mm Hg. A nondipping diurnal blood pressure pattern was present in 13 patients. After conversion to azathioprine, mean 24-hour blood pressure decreased to 109 +/- 3 mm Hg (P < .001), the nocturnal fall increased to 9 +/- 6 mm Hg, and the number of patients with a nondipping diurnal blood pressure pattern decreased to 9. The nocturnal fall in heart rate (17 +/- 10 beats per minute) during cyclosporin A did not change after conversion. Body weight and plasma concentrations of norepinephrine and renin did not change. Plasma concentrations of prostaglandin E2 and thromboxane B2 decreased after conversion, as did plasma atrial natriuretic peptide. Renal blood flow and glomerular filtration rate increased after conversion. In conclusion, cyclosporin A appears to be involved in the disturbance of the circadian blood pressure rhythm in renal transplant recipients. Although the precise mechanism is unclear. the elevated plasma atrial natriuretic peptide and slightly suppressed plasma renin concentrations suggest that intravascular volume expansion may contribute to the observed hemodynamic alterations.
在肾移植受者中，经常发现高血压和夜间血压下降幅度减小的情况。为了研究这种夜间血压下降幅度减小是与使用环孢素A有关，还是与其他因素（如使用糖皮质激素）有关，我们对18例肾移植受者在从环孢素A转换为硫唑嘌呤之前和之后16周测量了24小时动态血压。分别通过131I-马尿酸盐和125I-碘肽酸盐清除率估算肾血流量和肾小球滤过率，并测定血浆肾素、心房利钠肽、去甲肾上腺素、前列腺素E2和血栓素B2的浓度。在环孢素A治疗期间，平均24小时血压为117±3 mmHg，夜间血压下降幅度为4±9 mmHg。13例患者出现非勺型日间血压模式。转换为硫唑嘌呤后，平均24小时血压降至109±3 mmHg（P<0.001），夜间血压下降幅度增至9±6 mmHg，非勺型日间血压模式的患者数量降至9例。转换后，环孢素A治疗期间的夜间心率下降幅度（每分钟17±10次）未改变。体重以及去甲肾上腺素和肾素的血浆浓度未改变。转换后，前列腺素E2和血栓素B2的血浆浓度降低，血浆心房利钠肽也降低。转换后肾血流量和肾小球滤过率增加。总之，环孢素A似乎参与了肾移植受者昼夜血压节律的紊乱。虽然确切机制尚不清楚，但血浆心房利钠肽升高和血浆肾素浓度略有降低表明血管内容量扩张可能导致了观察到的血液动力学改变。
