Hypertension after liver transplantation - A predictive role for pretreatment hemodynamics and effects of isradipine on the systemic and renal circulations

Hypertension developing after liver transplantation during immunosuppressio n with cyclosporine A. reflects an unusual hemodynamic transition from peri pheral vasodilation to systemic and renal vasoconstriction. Although dihydr opyridine calcium channel blockers are often administered for their efficac y in promoting vasodilation, some liver transplant recipients report marked symptomatic intolerance to these agents. In the present study we examined systemic and renal responses to isradipine using systemic (thoracic bioimpe dance) and renal hemodynamic measurements in 15 liver transplant recipients studied at the time of initial diagnosis of posttransplant hypertension an d after 3 months of treatment. Circadian blood pressure patterns were exami ned by overnight ambulatory blood pressure monitoring before and during ant ihypertensive therapy. During isradipine administration, blood pressure dec reased from 151 +/- 3/91 +/- 2 to 130 +/- 3/81 +/- 2 mm Hg (P < .01) withou t change in renal blood flow (406 +/- 43 to 425 +/- 52 mL/min/1.73m(2), P = NS) or renal vascular resistance index (25,674 +/- 3312 to 20,520 +/- 2311 dynes . sec . cm(-5)/m(2), P = NS). Pre-treatment differences in systemic vascular tone persisted during treatment and predicted the tendency for sym ptomatic tachycardia and flushing, predominantly in those with hyperdynamic circulations. Twice daily dosing of isradipine was associated with partial and significant restoration of the nocturnal decrease in blood pressure (s ystolic blood pressure decreased 5.5%, normal 13%), usually absent early af ter transplantation. Our results demonstrate the ability of hemodynamic mea surements to predict the symptomatic response to antihypertensive therapy i n the posttransplant setting. Am J Hypertens 2000;13:231-239 (C) 2000 Ameri can Journal of Hypertension, Ltd.