Cyclosporine, blood pressure and atherosclerosis

Blood pressure rises soon after administration of immunosuppressive regimens using cyclosporin A. These changes lead to widespread vasoconstriction and increased risk for atherosclerosis. Changes in blood pressure are commonly associated with disturbed circadian regulation and may produce rapidly developing target injury, including intracranial hemorrhage, left ventricular hypertrophy and microangiopathic hemolysis. Mechanisms underlying this disorder are complex and include altered vascular endothelial function. Vasodilators such as prostacyclin and nitric oxide are suppressed, whereas vasoconstrictors, including endothelin, are increased. Changes in the kidney include vasoconstriction, reduced glomerular filtration and sodium excretion. When blood pressure effects are combined with the effects of glucocorticoids and weight gain, changes in cholesterol and triglycerides magnify the risk for atherosclerotic disease. Effective therapy depends upon rigorous blood pressure control and administration of vasodilating agents with attention to the interactions with cyclosporin A. Effective blood pressure control and lipid management is an important component in the long- term management of transplant recipients.