Arterial blood pressure oscillation after active standing up in kidney transplant recipients

Dynamic arterial blond pressure (FLNAPRES) response to active standing up, normally consisting of initial rise, fall and recovery above the baseline ( overshoot), was compared with the early steady-state arterial blood pressur e level to measure sympathetic vasomotor function in healthy subjects [grou p 1: n=50, 10 female subjects, age 51+/-2.5 years; weight 78+/-2.3 kg; heig ht 174+/-1.4 cm (mean+/-standard error of the mean)] and in kidney transpla nt recipients under basal (group 2a: n=50, age 51.7+/-1.7 years; weight 77/-2.1 kg; height 174+/-1.5 cm) and under high (group 2b: same subjects as i n group 2a) ciclosporine A whole blood levels. Furthermore, baroreflex sens itivity and the activity of the generating compounds of the sympathetic ner vous systems (Mayer waves) were measured. Systolic and diastolic overshoot values did not differ statistically significant in the present study. In th e control subjects, a systolic overshoot of 15.4+/-2.7 mmHg and a diastolic overshoot of 15.2+/-2 mmHg was detected. The systolic overshoot disappeare d in 57% of group 2a (-7.1+/-2.7 mmHg; P<0.001) and in 50% of group 2b reci pients (-8.0+/-2.7 mmHg; P<0.001). Systolic early steady-state level was no t lower in kidney transplant recipients before ciclosporine (baseline+2 mmH g) intake, but after ciclosporine administration (baseline-3 mmHg; controls : baseline+3 mmHg: P<0.05). There was a strong association between the over shoot and steady-state levels (P for chi(2)<0.001, n=150). Overshoot of gro up 1 levels (r=0.428; P<0.01) and group 2 levels (r=0.714; P<0.001) correla ted to their respective steady-state blood pressure. Furthermore, recipient s had reduced baroreceptor sensitivities estimated by sequence analysis as compared to controls (10+/-1 ms/mmHg vs. 7.5+/-1.4 ms/mmHg; P<0.05). Mayer waves amplitudes of the heart rate spectrum were elevated statistically sig nificant in renal transplant recipients (44.4+/-0.2 vs. 43.8+/-2.2 A.U.). I n conclusion, baroreceptor rifler-dependent overshoot of the arterial blood pressure after active standing up is diminished in kidney transplant recip ients, whereas no association to the ciclosporine A whole blood level has b een detected. The reduced overshoot may be due to the diminished barorecept or sensitivity which could be shown in renal transplant recipients. (C) 200 0 Elsevier Science B.V. All rights reserved.