Hypertension after heart transplantation: predictive factors and number and classes of drugs for its management.
BACKGROUND
This study was performed to determine the factors that cause arterial hypertension after heart transplantation (HT) and the drugs used in its management.


METHODS
We studied 247 consecutive patients who had undergone HT between 2000 and 2006 and who survived for at least 6 months. We excluded patients who received combination transplants, those who underwent repeat transplantation, and pediatric patients who had received transplants. Hypertension was defined as the need to use drugs for its control. Renal dysfunction was defined as serum creatinine concentration greater than 1.4 mg/dL, and diabetes as the need for an antidiabetes drug for its control. Statistical analyses were performed using the t test, the chi(2) test, and Cox regression.


RESULTS
Mean (SD) patient age was 52 (10) years, and 87.4% of the patients were men. Follow-up was 72 (42) months. Hypertension was present in 33.3% of patients before HT and in 71.1% at some time after HT. The number of drugs used to control hypertension was 1.3 (0.5); one drug was used in 72.9% of patients. The most often used single class of drugs were calcium channel blockers (63.2%), followed by angiotensin-converting enzyme inhibitors (20%), and angiotensin receptor blockers (15.8%). Only pre-HT hypertension was significantly associated with greater use of antihypertensive drugs post-HT (mean [SD], 1.48 [0.65] vs 1.22 [0.41]; P = .005). At univariate analysis, only pre-HT hypertension was associated with the presence of post-HT hypertension (80.5% vs 65.5%; P = .02). At Cox regression analysis, recipient age (P = .02) and pre-HT hypertension (P = .004) were associated with post-HT hypertension.


CONCLUSIONS
Hypertension is common after HT; however, in most patients, it can be controlled with a single antihypertensive agent. The most important factors in the development of hypertension are the presence of pre-HT hypertension and advanced age.
Sánchez Lázaro
I J
IJ
Heart Failure and Transplantation Unit, La Fe University Hospital, Valencia, Spain; Department of Cardiology, La Fe University Hospital, Valencia, Spain. igsania@comv.es
Almenar Bonet
L
L
Martínez-Dolz
L
L
Moro López
J
J
Ramón-Llín
J Agüero
JA
Pérez
O Cano
OC
Soriano
J Rueda
JR
Fuentes
F Buendía
FB
Manchón
J Navarro
JN
Sánchez Gómez
J M
JM
Sanz
A Salvador
AS
D000328:Adult; D000959:Antihypertensive Agents / Q000145:classification / Q000627:therapeutic use*; D003404:Creatinine / Q000097:blood; D003920:Diabetes Mellitus / Q000188:drug therapy / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000453:epidemiology*; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011183:Postoperative Complications / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology; D011237:Predictive Value of Tests; D012044:Regression Analysis; D012189:Retrospective Studies; D013997:Time Factors
D000959:Antihypertensive Agents; D007004:Hypoglycemic Agents; D003404:Creatinine