Hypertension in cardiac transplant recipients

Шевченко, А. О.; Никитина, Е. А.; Тюняева, И. Ю.

doi:10.15825/1995-1191-2017-2-114-125

Cited by 2 publications

(1 citation statement)

References 59 publications

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“…Артериальная гипертензия (АГ) является одним из наиболее важных модифицируемых факторов риска развития почечной недостаточности, ишемической болезни сердца, нарушений ритма и сердечной недостаточности [3]. АГ, развивающаяся после трансплантации сердца (ТС), имеет свои отличительные черты, определяемые, с одной стороны, необходимостью в пожизненном приеме комбинации иммуносупрессивных лекарственных средств, обладающих рядом побочных действий, с другойособенностями регуляции уровней артериального давления (АД) у пациентов с денервированным серд цем, включающими отсутствие вагусного влияния, сенсибилизацию к эндогенным катехоламинам, гуморальную регуляцию сердечной деятельности, а также нарушение барорефлексов, сопровождающееся задержкой жидкости [4].…”

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Controlled arterial hypertension and adverse event free survival rate in heart recipients

Шевченко

Никитина

Колоскова

et al. 2018

Cardiovasc Ther Prev

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Aim. To evaluate the prevalence of arterial hypertension (AH) in heart transplant recipients, and its influence on the risk of adverse events, as the efficacy and safety of antihypertension medications (AHM).Material and methods. To the study, were consequently included all heart transplant recipients operated in the Shumakov Centre during the years 2013 to 2016 and survived 90 days after orthotopic heart transplantation.Results. Totally, 353 recipients included, with AH or AHM intake in anamnesis in 62 (17,6%). Within 90 days post-surgery, AH that demanded for medication therapy was found in 151 (42,8%) patients. In posttransplant AH patients there were the following specific parameters in preoperational period: higher body mass index — 25,7±4,1 vs 24,9±4,4 (р=0,026), blood creatinine concentration — 100,6±62,6 vs 68,8±4,8 (р<0,001), donor heart posterior wall thickness — 11,9±0,8 vs 11,3±0,7 (р=0,034), creatinine concentration in 3 month after operation — 131,7±101,6 vs 94,1±46,5 (p<0,001). There was relation revealed, of AH development risk with anamnesis of AH and renal failure, as a necessity for renal replacement therapy within 30 days post surgery and episodes of acute antibody-mediated reaction on transplant. In the recipients taking angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers (ACEi/ARB) before operation, the survival rate free from adverse events was better than in those taking calcium channel blockers (CCB) (plog-rank=0,042).Conclusion. The results of the study point on high prevalence of AH in heart recipients. Presence of AH in anamnesis, renal failure, episodes of humoral, but not cellular, reaction to the transplant, and donor heart hypertrophy do significantly increase the probability of AH development after transplantation. Comparison revealed significant benefit of ACEi/ ARB versus CCB as antihypertension medications in either monotherapy or in combination with diuretics.

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Section: Introductionunclassified

Controlled arterial hypertension and adverse event free survival rate in heart recipients

Шевченко

Никитина

Колоскова

et al. 2018

Cardiovasc Ther Prev

Self Cite

View full text Add to dashboard Cite

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Arterial hypertension after heart transplantation

et al. 2020

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Aim To evaluate incidence of arterial hypertension (AH) in the posttransplantation period and to identify risk factors for this complication.Materials and methods From January, 2010 through December, 2017, 96 heart transplantations (HT) (70 men and 26 women aged 46.5±13.9 years) were performed. During the first month following HT, 8 recipients died and were excluded from the analysis. The retrospective evaluation of results included 88 patients followed up for more than one year.Results For the entire post-HT period (maximum 92 months), AH was observed in 75 of 88 (85%) recipients. Post-HT AH was correlated with male gender (r=0.24; p=0.031), history of smoking before HT (r=0.45; p<0.001), history of ischemic heart disease (IHD) (r=0.28; p=0.01), older age (r=0.35; p=0.001), higher body weight index (r=0.37; p=0.0005), creatinine level (r=0.37; p=0.001), and low-density lipoprotein cholesterol level (r=0.27; p=0.04). Interrelations with other AH risk factors were not found. Most patients developed AH within the first two years after HT. During the first year, AH was diagnosed in 60% (53 of 88) of patients (relapse, 85% (n=29); newly diagnosed, 45% (n=24), p=0.0003). At two years, AH was detected in 79% (46 of 58) of patients (relapse, 53% (n=18); newly diagnosed, 53% (n=28), p=0.9). All recipients received an adequate antihypertensive therapy. 40-63% of patients required a single-drug therapy at different points of follow-up; from 29 to 45% of patients required a two-drug therapy, and 5-15% of patients required three or more drugs. During all 5 years of treatment, most patients used angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) (70-87%) and slow calcium channel blockers (SCCB) (48-53%). The presence of AH following HT was associated with development of all cardiovascular events (CVE; r=0.31; p=0.012) whereas persistent AH, which required a combination antihypertensive treatment, was associated with a high mortality (r=0.61; p=0.015).Conclusion AH is a frequent complication of HT (85%), which is newly diagnosed in most patients during the first two years. AH incidence was higher for male recipients with a history of IHD, hypertension, and smoking. Approximately half of patients required only a single-drug antihypertensive therapy. After HT, the most frequently prescribed drugs included ACE inhibitors or ARBs and SCCBs (70-87% and 48-53%, respectively, depending on the time elapsed after HT). Persistent AH requiring a treatment with two or more antihypertensive drugs was associated with development of all CVEs and a higher long-term mortality.

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Hypertension in cardiac transplant recipients

Cited by 2 publications

References 59 publications

Controlled arterial hypertension and adverse event free survival rate in heart recipients

Controlled arterial hypertension and adverse event free survival rate in heart recipients

Arterial hypertension after heart transplantation

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