Cyclosporin-induced hypertension - Incidence, pathogenesis and management

Blood pressure increases soon after administration of immunosuppressive reg imens using cyclosporin. Characteristic vascular changes lead to systemic a nd renal vasoconstriction. Changes in blood pressure are commonly associate d with disturbed circadian regulation and may promote the rapid development of target organ injury, including intracranial haemorrhage, left ventricul ar hypertrophy and microangiopathic haemolysis. The mechanisms underlying t his 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 kidn ey include vasoconstriction, reduced glomerular filtration and sodium reten tion. Effective therapy depends upon rigorous blood pressure control by adm inistration of vasodilating agents, with attention to potential interaction s with cyclosporin .