Cyclosporine-induced sympathetic activation and hypertension after heart transplantation

Details

Serval ID
serval:BIB_6EE37953469A
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Cyclosporine-induced sympathetic activation and hypertension after heart transplantation
Journal
New England Journal of Medicine
Author(s)
Scherrer  U., Vissing  S. F., Morgan  B. J., Rollins  J. A., Tindall  R. S., Ring  S., Hanson  P., Mohanty  P. K., Victor  R. G.
ISSN
0028-4793 (Print)
Publication state
Published
Issued date
09/1990
Volume
323
Number
11
Pages
693-9
Notes
Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.
Research Support, U.S. Gov't, P.H.S. --- Old month value: Sep 13
Abstract
BACKGROUND. Hypertension is a frequent complication of cyclosporine-induced immunosuppression, but the underlying mechanism is unknown. In anesthetized animals, the administration of cyclosporine increases sympathetic-nerve discharge, which may contribute to hypertension. METHODS. To determine whether cyclosporine-induced hypertension is accompanied by sustained sympathetic neural activation in patients, we recorded sympathetic action potentials using intraneural microelectrodes (in the peroneal nerve) in heart-transplant recipients receiving azathioprine and prednisone alone (n = 5) or in combination with cyclosporine (n = 14). We performed the same studies in eight patients with myasthenia gravis who were receiving cyclosporine and eight who were not, in five patients with essential hypertension, and in nine normal controls. RESULTS. Heart-transplant recipients receiving cyclosporine had higher mean arterial blood pressure (+/- SE) than those not receiving cyclosporine (112 +/- 3 vs. 96 +/- 4 mm Hg; P less than 0.05) and a 2.7-fold higher rate of sympathetic-nerve firing (80 +/- 3 vs. 30 +/- 4 bursts per minute; P less than 0.05). For patients with myasthenia gravis, similar doses of cyclosporine were associated with smaller elevations in mean arterial blood pressure (100 +/- 2 mm Hg, as compared with 91 +/- 4 mm Hg in those not receiving cyclosporine; P less than 0.05) and in the rate of sympathetic-nerve firing (46 +/- 3 bursts per minute, as compared with 25 +/- 4 bursts per minute; P less than 0.05). Sympathetic activity in patients with heart transplants or myasthenia gravis who were not being treated with cyclosporine was no different from that in patients with essential hypertension or in normal controls. CONCLUSIONS. Cyclosporine-induced hypertension is associated with sympathetic neural activation, which may be accentuated by the cardiac denervation that results from heart transplantation.
Keywords
Action Potentials/drug effects Adult Aged Blood Pressure/drug effects Cyclosporins/*adverse effects/pharmacology Female Heart/innervation *Heart Transplantation Humans Hypertension/*chemically induced Male Middle Aged Myasthenia Gravis/physiopathology Norepinephrine/blood Postoperative Complications Sympathetic Nervous System/*drug effects
Pubmed
Web of science
Create date
25/01/2008 14:04
Last modification date
20/08/2019 14:28
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