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[Incidence of systemic hypertension after orthotopic heart transplantation]
1Program výzkumu kardiovaskulárních nemocí, Institutu klinické a experimentální medicíny, Praha.
Insights
Hypertension is common after heart transplants due to denervation and abnormal baroreceptor response. Blood pressure may rise at night, unlike in healthy individuals, impacting transplant patient cardiovascular health.
Area of Science:
- Cardiology
- Transplantation Medicine
- Nephrology
Context:
- Orthotopic heart transplantation (OTH) patients often develop hypertension.
- Immunosuppressive therapy (Cyclosporin A, corticoids, azathioprine) is standard post-OTH.
- The pathophysiology of post-OTH hypertension remains unclear.
Purpose:
- To investigate the prevalence and circadian blood pressure patterns in OTH patients.
- To explore potential mechanisms contributing to hypertension post-OTH.
Summary:
- Systemic hypertension was observed in 6/18 and borderline hypertension in 3/18 OTH patients.
- Unlike normotensive and essential hypertension groups, OTH patients exhibited a nocturnal blood pressure rise instead of a drop.
- This abnormal circadian rhythm may stem from cardiac denervation, altered baroreceptor response, and corticosteroid effects.
Impact:
- Findings suggest cardiac denervation and abnormal baroreceptor function contribute to post-OTH hypertension.
- The nocturnal blood pressure surge is a key characteristic differentiating OTH hypertension.
- Understanding these mechanisms can inform strategies for managing hypertension in heart transplant recipients.
Abstract:
In a group of 18 patients after orthotopic transplantation of the heart (OTH) operated, 4-56 months previously and treated by combined immunosuppression (Cyclosporin A, corticoids, azathioprine), systemic hypertension was revealed in six and borderline hypertension in three patients. The mechanism of the development of hypertension, after OTH has not been elucidated. As to the circadian rhythm of the blood pressure, as compared with normotensive subjects and patients with essential hypertension, in patients after OTH usually the drop of systemic pressure values does not occur during the night; on the contrary the blood pressure rises during the night. This finding may be due to denervation of the heart after OTH and an abnormal response of baroreceptors to the rise of blood pressure; in this the effect of corticoids may also participate. After a one-year interval the abnormal reaction of the systolic pressure remains preserved, while the 24-hour profile of the diastolic pressure has trend towards normalization.