Effect of cyclosporine on blood pressure.
Author(s): Robert N, Wong GW, Wright JM.
Affiliation(s): Institut of Social and Preventive Medicine, University of Bern, Finkenhubelweg
11, Bern, Bern, Switzerland, CH-3012.
Publication date & source: 2010, Cochrane Database Syst Rev. , (1):CD007893
BACKGROUND: Cyclosporine is an immunosuppressive agent used for different
autoimmune diseases. The official Canadian indications for cyclosporine are solid
organ transplantation, bone marrow transplantation, psoriasis, rheumatoid
arthritis and nephritic syndrome (e-CPS 2008). The expanding range of indications
for cyclosporine therapy will lead to more patients receiving chronic therapy
with possible side effects, hypertension being one of the most common. Therefore
it is essential to know the magnitude of increase of blood pressure (BP)
associated with cyclosporine in order to appropriately manage patients receiving
the drug.
OBJECTIVES: The primary objective of this systematic review is to evaluate the
effect of cyclosporine on blood pressure, compared to placebo in randomized
trials.
SEARCH STRATEGY: We searched The Cochrane Central Register of Controlled Trials
(CENTRAL) and bibliographic databases, including MEDLINE (2000-2008) and EMBASE
(1980-2008).
SELECTION CRITERIA: Selection was made using double-blind, randomized, controlled
trials comparing cyclosporine to placebo. All patients treated with cyclosporine
were included without restriction by type of disease or by age and sex.
DATA COLLECTION AND ANALYSIS: Blood pressure measurements in any setting and by
any means were acceptable including the auscultatory or oscillometric method with
a preference for the sitting position. Mean blood pressure results were entered
as mean change from placebo and standard error of the mean (SEM). If blood
pressure data was provided at different times after the initiation of
cyclosporine therapy the weighted mean BP change from placebo from all
measurements was used.
MAIN RESULTS: The search yielded 1340 citations, of which 17 trials met the
inclusion criteria. We created dose-ranges according to the usual dose
administration recommended by the manufacturer and allocated the 17 included
trials to the corresponding dose-range. The results demonstrate a highly
statistically significant increase in blood pressure associated with
cyclosporine. There appears to be a dose-related effect with lower doses (1-4
mg/kg/d) increasing mean BP by an average of 5 mmHg and higher doses (>10
mg/kg/d) increasing mean BP by 11 mmHg on average. Furthermore in 3 trials the
effect appears to be similar after a single dose as with chronic therapy.
AUTHORS' CONCLUSIONS: Cyclosporine statistically significantly increases blood
pressure compared to placebo in a dose-related fashion. The magnitude of increase
in blood pressure is clinically significant and increases the risk of stroke,
myocardial infarction, heart failure and other adverse cardiovascular events
associated with elevated BP. Consequently prescribers should try to find the
lowest effective dose in all patients receiving cyclosporine chronically.
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