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[Treatment of arterial hypertension in patients with organ transplantation]
1Service de Médecine Interne et Pathologie Vasculaire, Hôpital Saint-Louis, Paris.
Insights
Post-organ transplant hypertension (HT) is common, often caused by immunosuppressants like cyclosporin. Effective management requires tailored antihypertensive drug strategies considering transplant type and drug interactions.
Area of Science:
- Nephrology
- Pharmacology
- Transplant Medicine
Context:
- Post-organ transplantation complication
- Hypertension (HT) linked to immunosuppressants, especially cyclosporin
- Cyclosporin's nephrotoxic, vasoconstrictor effects
Purpose:
- Outline management of post-transplant hypertension
- Detail drug choices and interactions with cyclosporin
- Provide transplant-specific treatment considerations
Summary:
- Systolic hypertension is a frequent complication post-organ transplant.
- Cyclosporin-induced vasoconstriction is a primary cause.
- Treatment involves arteriolar vasodilators, often combined, considering transplant type and drug interactions.
- Calcium channel blockers, ACE inhibitors, diuretics, and beta-blockers have specific roles and precautions.
- Centrally-acting agents are a secondary treatment option.
Impact:
- Guides clinical practice for managing post-transplant hypertension.
- Highlights the importance of personalized antihypertensive therapy.
- Emphasizes careful drug selection to avoid adverse interactions and optimize outcomes.
Abstract:
The onset of predominantly systolic hypertension (HT) is the most common complication following organ transplantation. The hypertension is directly linked to the immunosuppressant treatment, particularly to the nephrotoxic and intrarenal and peripheral vasoconstrictor effects of cyclosporin. Treatment is based on the primary use of arteriolar vasodilators, but must be appropriate for the organ transplanted and the degree of HT. It is often necessary to administer two or three antihypertensive drugs, which must take into account the precautions for their use and possible interactions with cyclosporin: calcium channel inhibitors inhibit the vasoconstriction induced by cyclosporin, converting enzyme inhibitors slow the compensatory glomerular hyperfiltration, diuretics are effective versus this type of HT, which is sensitive to sodium depletion, and beta-blockers are useful in hypertensive patients who have undergone kidney or liver transplants, but less commonly used in cardiac transplant patients. Centrally-acting antihypertensives are used as a second option.