Cyclosporine-induced hypertension after transplantation.

OBJECTIVE: To describe the features and mechanisms of posttransplantation hypertension and suggest appropriate management of the disorder. DESIGN: We review our own experience and reports from the literature on hypertension in cyclosporine A (CSA)-treated transplant recipients. RESULTS: Soon after immunosuppression with CSA and corticosteroids, hypertension develops in most patients who undergo transplantation. The blood pressure increases, which are usually moderate, occur universally because of increased peripheral vascular resistance. Disturbances in circadian patterns of blood pressure lead to loss of the normal nocturnal decline, a feature that magnifies hypertensive target effects. Changes in blood pressure sometimes are severe and associated with rapidly developing target injury, including intracranial hemorrhage, left ventricular hypertrophy, and microangiopathic hemolysis. The complex mechanisms that underlie this disorder include alterations in vascular reactivity that cause widespread vasoconstriction. Vascular effects in the kidney lead to reduced glomerular filtration and impaired sodium excretion. Many of these changes affect local regulation of vascular tone, including stimulation of endothelin and suppression of vasodilating prostaglandins. Effective therapy includes use of vasodilating agents, often calcium channel blocking drugs. Caution must be exercised to avoid interfering with the disposition of CSA or aggravating adverse effects relative to kidney and electrolyte homeostasis. CONCLUSION: Recognition and treatment of CSA-induced hypertension and vascular injury are important elements in managing the transplant recipient.

Hypertension: role of the nurse-therapist.

In this article, we describe the evolution of the hypertension nurse-therapist program at the Mayo Clinic. Because of the large numbers of patients in whom hypertension is a major risk factor for cardiovascular disease, a leading cause of death in the United States and other industrialized nations, an approach was devised in which, with physician supervision, specially trained nurses managed many aspects of the acute and long-term outpatient care of hypertensive patients. Clinical trials in which nonphysician care-providers were used to treat hypertensive patients and to maintain long-term blood pressure control provided an opportunity to identify and to expand the concept of continuing care for blood pressure management in a community hypertension clinic. Currently, almost 7,000 patient visits are scheduled annually in this program, and these patients are seen by five full-time hypertension nurse-therapists.