Traditional drug therapy of hypertension in transplant recipients

Abstract

Hypertension is a very common condition among recipients of transplanted organs, and is often related to immunosuppressive therapy. In many transplant centres, calcium antagonists are often used as first-line antihypertensive drug therapy, not only because of efficacy in lowering blood pressure, but also because certain members of the class have a 'beneficial' drugdrug interaction with cyclosporin, which decreases the cost of administering this very expensive immunosuppressant. Diuretics are often used both for blood pressKeywords: transplant recipients; cyclosporin; calcium antagonists IntroductionThe elevation of blood pressure (BP) which commonly occurs in transplant recipients increases the risk of cardiovascular complications in these patients, just as hypertension increases risk in patients who have all of their own original organs intact.1,2 Probably because of the elevated absolute risk, it has taken fewer patients to demonstrate the benefits of lowering elevated BPs in transplant recipients than in pretransplant patients.3 Because of this higher absolute risk, there are special considerations which arise in the treatment of hypertension in transplant recipients which are not present in patients with all native organs present. 1When the issue of 'traditional drug therapy of hypertension in the transplant recipient' is addressed, multiple questions come to mind which must be answered before recommendations for a specific patient can be given. Several of these questions include: (1) 'Which are the "traditional drugs" that should be considered?' (2) 'Which organ was transplanted?' which in the USA is a way of asking also, 'Which physicians are caring for the patient?' (3) 'Which of the common sequelae of hypertension are we attempting to prevent with our treatment?' The answers to these questions must be sought before individualising therapy, because patients with different transplanted organs should be protected from the ravages of high BP, which manifests in different ways.

Hypertension in kidney transplant recipients

“…On the other hand, this class of drugs has demonstrated a number of effects that may be of benefit to transplant recipients. ACE‐i reduce mortality following myocardial infarction, improve symptoms and prolong survival of patients with heart failure [93–95]. ARB and ACE‐i may also prevent heart failure in patients with left ventricular dysfunction, and may favour the regression of left ventricular hypertrophy [96,97].…”

Beta‐blocker therapy in heart transplant recipients: A review

“…43 Angiotensin-converting enzyme inhibitors are used particularly in the case of corticosteroid-induced hypertension, 44 and diuretics are considered in cases involving fluid overload. 45 was observed between the two groups in terms of mortality (P = .13) and number of hospitalizations (P = .44)]. 46…”

“…Calcium antagonists are typically the first drugs used for the management of hypertension in HTRs 43 . Angiotensin‐converting enzyme inhibitors are used particularly in the case of corticosteroid‐induced hypertension, 44 and diuretics are considered in cases involving fluid overload 45 . A recent retrospective study by Ghotra et al that included 31 HTRs with resistant hypertension reported that BBs (mostly carvedilol) maintained adequate blood pressure control without serious adverse effects [no significant difference was observed between the two groups in terms of mortality ( P = .13) and number of hospitalizations ( P = .44)] 46 …”

Increase in Treatment-Refractory Hypertension: Progress in Current Treatment by Primary Care

“…While the management of transplant hypertension exceeds the scope of this review, prior reviews indicate that dihyrdopyridine calcium channel blockers are useful either alone or in combination with other classes of antihypertensive medications. 30,31 Sympathomimetic agents, e.g., phenylpropanolamine and cocaine can raise blood pressure. 1,17 Oral contraceptives contribute to hypertension, although the percentage of women taking these agents who have treatment resistant hypertension is likely low, especially in contemporary formulations that typically have lower doses of hormones than previous generation agents.…”