Farmacotherapy of hypertension after heart transplantation

Česká verzia

Authors: L. Špinarová; P. Hude; J. Krejčí; H. Poloczková; J. Godava; J. Vítovec
Authors place of work: I. interní kardioangiologická klinika Lékařské fakulty MU a FN u sv. Anny – ICRC Brno, přednosta prof. MUDr. Jiří Vítovec, CSc., FESC
Published in the journal: Vnitř Lék 2012; 58(7 a 8): 224-227
Category: 60th Birthday prof. MUDr. Miroslav Souček, CSc.

Summary

Heart transplantation is now used for the treatment of severe heart failure. In a long-term patient follow-up, hypertension has been identified as a complication. Incidence of hypertension in patients treated with cyclosporine and prednisone is between 70–90%. Besides the traditional mechanisms (renin-angiotensin system, fluid volume and peripheral resistance), aetiology of hypertension includes negative effect of cardiac denervation, cyclosporine immunosuppression, administration of corticosteroids and nephropathy. There is no night drop in the blood pressure and heart rate. Treatment aims to maintain cyclosporine level as low as possible and, if feasible, to discontinue steroids during the first year. Hypertension is usually treated with a combination therapy. Our own observations suggest that the majority of post-transplantation patients have a dual therapy. Calcium channel blockers should be the treatment of choice as they also have an effect on graft vasculopathy. Angiotenzin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARB), beta-blockers and diuretics are also recommended. Long-acting products should be preferred.

Key words:
heart transplantation – hypertension – pharmacotherapy

Zdroje

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