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Efficacy of antihypertensive medication in orthotopic heart transplant recipients and its effect on renal function
D Schechter1, G M Ziady, A Lee
1University of Pittsburgh, Presbyterian-University Hospital, PA.
Insights
Antihypertensive medications like hydralazine, ACE inhibitors, and beta-blockers showed no significant impact on mean arterial pressure post-heart transplant. However, ACE inhibitors were associated with higher initial blood urea nitrogen levels compared to beta-blockers.
Area of Science:
- Nephrology
- Cardiology
- Pharmacology
Background:
- Orthotopic heart transplant recipients often require antihypertensive therapy.
- Cyclosporine-based immunosuppression is common in these patients.
- The impact of different antihypertensive classes on renal function in this population is not fully understood.
Purpose of the Study:
- To evaluate the effects of hydralazine, angiotensin-converting enzyme (ACE) inhibitors, and beta-adrenergic blocking agents on mean arterial pressure (MAP) and renal function in heart transplant patients.
- To compare the efficacy and safety of these antihypertensive regimens in maintaining hemodynamic stability and preserving kidney function.
Main Methods:
- Retrospective analysis of 77 patients post-orthotopic heart transplant on triple immunosuppression.
- Patients were divided into three groups based on antihypertensive medication: hydralazine, ACE inhibitors, or beta-blockers.
- Mean arterial pressure (MAP), serum blood urea nitrogen (BUN), and serum creatinine (CR) were measured at baseline and end of follow-up.
Main Results:
- No statistically significant differences in MAP were observed among the three groups at baseline or end of follow-up.
- Serum BUN was significantly higher in the ACE inhibitor group compared to the beta-blocker group at baseline (34 +/- 9 vs. 25 +/- 8 mg/dL, P < 0.05).
- This significant difference in serum BUN between the ACE inhibitor and beta-blocker groups was maintained throughout the follow-up period.
Conclusions:
- Hydralazine, ACE inhibitors, and beta-blockers appear to have comparable effects on MAP in heart transplant patients on cyclosporine.
- ACE inhibitors may be associated with a higher initial burden of renal dysfunction (as indicated by BUN) compared to beta-blockers in this patient cohort.
- Further prospective studies are warranted to confirm these findings and elucidate the long-term renal implications of different antihypertensive strategies post-heart transplant.
Abstract:
The authors looked at 77 patients following orthotopic heart transplant who received a triple immunosuppressive regimen including cyclosporine to see the effect of various antihypertensive medications on mean arterial blood pressure and renal function. There were 62 men and 15 women retrospectively classified into three groups according to the antihypertensive medications they received. Group 1 included 26 patients followed up for 10.7 +/- 2.7 months who received hydralazine therapy. Group 2 included 32 patients followed up for 9.0 +/- 3.4 months who received angiotensin-converting enzyme inhibition therapy. Group 3 included 19 patients followed up for 10.1 +/- 3.3 months who received beta-adrenergic blocking agents. Mean arterial pressure (MAP), serum blood urea nitrogen (BUN), and serum creatinine (CR) were determined for each group at the start and end of the follow-up period. The MAP at the start of the study was 107 +/- 14 in group 1, 110 +/- 13 in group 2, and 100 +/- 11 in group 3. It was not statistically significantly different in any of the groups. At the end of the follow-up period, MAP was 112 +/- 10, 111 +/- 10, and 106 +/- 12 for the three groups respectively, and it was not significantly different in any group. The serum BUN in group 3 was 25 +/- 8 mg/dL at the start of the study, and it was not significantly lower than that in group 1, 28 +/- 6, but it was significantly different from that in group 2, 34 +/- 9, P less than 0.05. At the end of the follow-up period, the difference was still maintained.(ABSTRACT TRUNCATED AT 250 WORDS)