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[Arterial hypertension in heart transplant recipients]
J Julien1, D Farge, R Guillemain
1Service d'Hypertension artérielle, Hôpital Broussais, Paris.
Insights
Post-cardiac transplant arterial hypertension is common, affecting 40-100% of patients, often linked to cyclosporin. This condition impacts heart and kidney function, with cyclosporin being a primary cause requiring further treatment investigation.
Area of Science:
- Cardiology
- Nephrology
- Pharmacology
Context:
- Arterial hypertension is a frequent complication following cardiac transplantation.
- The incidence of hypertension has increased significantly since the introduction of cyclosporin, affecting 40-100% of patients.
- The onset and severity of this hypertension are variable.
Purpose:
- To review the incidence, impact, and potential mechanisms of arterial hypertension after cardiac transplantation.
- To highlight the role of cyclosporin in the development of post-transplant hypertension.
- To discuss the implications for cardiac and renal function.
Summary:
- Post-transplant hypertension is a significant concern, with cyclosporin identified as a major contributing factor.
- This condition exacerbates left ventricular hypertrophy, transplant dysfunction, and cyclosporin-induced renal impairment.
- Potential contributing mechanisms include impaired neurological control, hemodynamic effects, and the influence of corticosteroids and cyclosporin.
Impact:
- Understanding the mechanisms and impact of cyclosporin-induced hypertension is crucial for patient management.
- Further research is needed to establish optimal treatment strategies for this iatrogenic condition.
- Improved management can lead to better long-term outcomes for cardiac transplant recipients.
Abstract:
Arterial hypertension is frequent after cardiac transplantation. Since cyclosporin was introduced its incidence has risen up to 40 to 100 per cent of the patients. Its date of onset and severity are variable. Arterial hypertension acts on the heart by increasing left ventricular hypertrophy and transplant dysfunction and on the kidney by aggravating the cyclosporin-induced renal impairment which is often present. Several mechanisms have been suggested to account for the occurrence of hypertension in these patients, including poor neurological control of blood pressure, a hypothetical haemodynamic effect and the influence of corticosteroids and cyclosporin. Cyclosporin seems to play the main role. The treatment of this iatrogenic arterial hypertension remains to be precisely determined.