[Long-term course and complications of arterial hypertension after heart transplantation].
OBJECTIVE
To evaluate the progression of arterial hypertension (AH) and its consequences, in patients submitted to cardiac transplantation (CT) in use of cyclosporine (CY).


METHODS
In 65 patients submitted to orthotopic CT, we evaluated blood pressure, serum creatinine and blood levels of CY before, 15 and 30 days, and 6, 12, 24, 48 and 60 months after CT; in 20 patients we analyzed cardiac index and systemic vascular resistance pre-CT, 15 and 30 days, 6 and 12 months after CT; in 33 patients, we studied anatomic and functional modifications by echocardiography, 24 +/- 13 months after CT.


RESULTS
Thirty days after CT, AH was present in 58.5% (50% mild), and after one year, 93% of patients were hypertensives (85% moderate-to-severe), remaining unchanged during the rest of follow-up. The serum creatinine progressively increased, reaching values significantly higher than those pre-CT after one year, persisting with a mild increment until 60 months. Echocardiography showed left ventricle hypertrophy in 54% of patients, all of which had normal function. Two patients died as a direct consequence of hypertensive complications.


CONCLUSIONS
AH in patients submitted to CT on CY use occurs early, increases in prevalence and severity during the follow-up and is mediated by an increase in vascular resistance. Also, the AH does not correlate to CY blood levels or nefrotoxicity, but it can impair renal function and compromise longevity of transplantation by inducing ventricular hypertrophy.
Bortolotto
L A
LA
Instituto do Coração do Hospital das Clínicas-FMUSP.
Silva
H B
HB
Bocchi
E A
EA
Bellotti
G
G
Stolf
N
N
Jatene
A D
AD
D001794:Blood Pressure / Q000187:drug effects; D003404:Creatinine / Q000097:blood; D016572:Cyclosporine / Q000097:blood / Q000494:pharmacology; D005260:Female; D016027:Heart Transplantation; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000503:physiopathology*; D007166:Immunosuppressive Agents / Q000097:blood / Q000494:pharmacology; D008297:Male; D011184:Postoperative Period; D051437:Renal Insufficiency / Q000209:etiology / Q000503:physiopathology; D013997:Time Factors
D007166:Immunosuppressive Agents; D016572:Cyclosporine; D003404:Creatinine
Evolução a longo prazo e complicações da hipertensão arterial após transplante cardíaco.