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Effect of systemic hypertension on renal function and left ventricular hypertrophy in heart transplant recipients
1Service de Chirurgie Cardio-vasculaire, Hôpital Broussais, Paris, France.
Insights
Post-cardiac transplant hypertension is common, affecting 67% of patients and indicating faster renal function decline. Hypertensive patients also show sustained enhanced heart contractility, suggesting a link to cyclosporine nephrotoxicity.
Area of Science:
- Cardiology
- Nephrology
- Transplantation Medicine
Background:
- Systemic hypertension is a potential complication following cardiac transplantation.
- Immunosuppressive therapy, particularly cyclosporine, may influence cardiovascular and renal health post-transplant.
Purpose of the Study:
- To assess the incidence, risk factors, and effects of systemic hypertension on renal function and left ventricular hypertrophy after cardiac transplantation.
- To investigate the relationship between hypertension, renal function, and cardiac remodeling in heart transplant recipients.
Main Methods:
- A cohort of 85 heart transplant recipients on triple-drug, low-dose immunosuppressive therapy was studied.
- Follow-up included monitoring for hypertension, renal function (serum creatinine), and left ventricular hypertrophy (echocardiography).
Main Results:
- A high incidence of hypertension (67%) was observed, with 71% developing new-onset hypertension post-transplant.
- No significant pre- or post-transplant cardiovascular risk factors were associated with post-transplant hypertension.
- Hypertensive patients showed faster renal function deterioration, indicating potential cyclosporine nephrotoxicity.
- Both hypertensive and normotensive recipients exhibited early increases in left ventricular mass and fractional shortening.
- Fractional shortening remained elevated in hypertensive patients, suggesting sustained enhanced contractility.
Conclusions:
- Post-transplant hypertension is frequent and associated with accelerated renal function decline and potential cyclosporine nephrotoxicity.
- Hypertension in heart transplant recipients may be linked to sustained enhanced cardiac contractility.
- Further research is needed to clarify the roles of cyclosporine dosage and hypertension in renal insufficiency and left ventricular hypertrophy.
Abstract:
To evaluate the incidence, risk factors and effects of systemic hypertension on renal function and left ventricular hypertrophy after cardiac transplantation, 85 transplant recipients on triple drug, low dosage, immunosuppressive therapy were studied. After a mean follow-up period of 12.5 +/- 8.7 months, a high incidence of hypertension was observed in 57 (67%) of the patients, and 42 (71%) of the 57 had developed new hypertension. None of the pretransplant and posttransplant cardiovascular risk factors were significantly associated with posttransplant hypertension. Faster deterioration of renal function, as assessed by intraindividual variations of serum creatinine values, was demonstrated in hypertensive patients and appeared as an early indicator of cyclosporine nephrotoxicity in patients at risk for hypertension. Serial echocardiographic evaluations demonstrated an early increase in left ventricular mass and fractional shortening in both hypertensive and normotensive heart transplant recipients. Fractional shortening further diminished significantly in normotensive patients but remained elevated in hypertensive patients, demonstrating sustained enhanced contractility in this group. Further studies will help to determine the exact relation between cyclosporine dosages and hypertension and their respective roles in the development of renal insufficiency and left ventricular hypertrophy after cardiac transplantation.