title: Mechanisms of hypertension after liver transplantation.
abstract: Hypertension is the most common cardiovascular complication after liver transplantation. Systemic vasoconstriction underlies transplant hypertension, but the mechanisms contributing to this remain unresolved. Plasma renin, aldosterone, and endothelin (ET)-1 together with augmentation index, a measure of arterial stiffness, were determined before and at intervals of 1, 3, and 6 months after transplant in 32 consecutive patients accepted for liver transplantation. At 3 months, 47% of patients were hypertensive, and at 6 months, 50% of patients were hypertensive. Plasma renin and aldosterone decreased after transplantation but were no different between hypertensive and normotensive patients. Plasma ET-1 levels were elevated pretransplant and decreased at 1 month, but at 6 months, levels were elevated in hypertensive patients but not in normotensive patients (P=0.019). Augmentation index increased after transplant and was greater in the hypertensive patients compared with the normotensive patients (P=0.031). During the first 6 months, the renin-aldosterone system does not play a significant role in posttransplant hypertension. Elevation in plasma ET-1 and increases in arterial stiffness are potential important mechanisms underlying the development of hypertension after liver transplant.
authors.affiliation: University Department of Medicine, Addenbrooke's Hospital, Cambridge CB2 2QQ, England, UK.
authors.forename: David A J
authors.initials: DA
authors.lastname: Neal
authors.forename: Morris J
authors.initials: MJ
authors.lastname: Brown
authors.forename: Ian B
authors.initials: IB
authors.lastname: Wilkinson
authors.forename: Graeme J M
authors.initials: GJ
authors.lastname: Alexander
mesh_terms: D000328:Adult; D000368:Aged; D000450:Aldosterone / Q000097:blood; D019332:Endothelin-1 / Q000097:blood; D005260:Female; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000209:etiology* / Q000503:physiopathology*; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012083:Renin / Q000097:blood; D013997:Time Factors
chemical_list: D019332:Endothelin-1; D000450:Aldosterone; D012083:Renin