Evaluation of Blood Pressure Medication Use Associated with Cyclosporine-Induced Hypertension in the Allogeneic Bone Marrow Transplant Population

Allogeneic bone marrow transplant (BMT) patients with cyclosporine-induced hypertension are at risk of serious complications including intracerebral hemorrhage and seizures.  There is little data describing cyclosporine-induced hypertension in the allogeneic BMT population.  The aim of this study was to characterize cyclosporine-induced hypertension in the allogeneic BMT population at the Medical University of South Carolina (MUSC), while also investigating what blood pressure (BP) medications currently used may be most efficacious. We conducted a single center, IRB approved, retrospective study of patients receiving an allogeneic BMT from January 1, 2008 to August 31, 2011.  Demographic data was collected for all patients.   Those patients experiencing cyclosporine-induced hypertension had additional data recorded: number of systolic blood pressure (SBP) readings > 160 mmHG, number of diastolic blood pressure (DBP) readings >100 mmHg, addition of an antihypertensive medication, and number of doses and dosage administered. Safety was assessed through recording number of SBP readings < 100 mmHG, number of DBP readings < 40 mmHg, and the minimum heart rate (HR) while on cyclosporine. Twenty seven (27) of 78 patients were identified as experiencing cyclosporine-induced hypertension.  Fifteen (15) patients received treatment with amlodipine while 14 received treatment with other antihypertensives, primarily beta blockers (n=11).  A significant difference was not found in the primary or secondary endpoints, which assessed safety and efficacy between the treatment groups.  Significant differences were found between those with and those without cyclosporine-induced hypertension.   Patients with cyclosporine-induced hypertension had a longer mean length of stay, 35.4 days (18-109) as compared to 24.1 days (7-74).  Zero of the 9 patients who received amlodipine prior to and during the BMT admission went on to experience cyclosporine-induced hypertension. Available results, although not robust, suggest that safety and efficacy are similar in allogeneic BMT patients whether they receive amlodipine or another antihypertensive to treat cyclosporine-induced hypertension.  However, the data provided did identify that those patients receiving amlodipine prior to and during their bone marrow transplant were less likely to experience cyclosporine-induced hypertension.