Hypertension and arterial stiffness in heart transplantation patients

Abstract

OBJECTIVES:Post-transplantation hypertension is prevalent and is associated with increased cardiovascular morbidity and subsequent graft dysfunction. The present study aimed to identify the factors associated with arterial stiffness as measured by the ambulatory arterial stiffness index.METHODS:The current study used a prospective, observational, analytical design to evaluate a group of adult heart transplantation patients. Arterial stiffness was obtained by monitoring ambulatory blood pressure and using the ambulatory arterial stiffness index as the surrogate outcome. Multivariate logistic regression analyses were performed to control confounding.RESULTS:In a group of 85 adult heart transplantation patients, hypertension was independently associated with arterial stiffness (OR 4.98, CI 95% 1.06-23.4) as well as systolic and diastolic blood pressure averages and nighttime descent.CONCLUSIONS:Measurement of ambulatory arterial stiffness index is a new, non-invasive method that is easy to perform, may contribute to better defining arterial stiffness prognosis and is associated with hypertension.

The Biological Parallels Between Atherosclerosis and Cardiac Allograft Vasculopathy: Implications for Solid Organ Chronic Rejection

“…143,144 These limitations generate an imbalance in our understanding of atherosclerosis, with the well-documented mechanistic knowledge of how LDL causes atherogenesis contrasting with considerably weaker knowledge of the role of other important risk factors. For example, hypertension is a risk factor for both chronic rejection and atherosclerosis, [145][146][147] with its deleterious effect on endothelial cells and sheer stress leading to endothelial dysfunction. 148,149 Despite this, there are very few animal models exploring the role of hypertension in atherosclerosis.…”

Anti‐hypertensive treatment in the immediate post‐operative period and 1 year after pediatric heart transplantation

“…Hypertension following transplant is associated with increased cardiovascular morbidity and mortality. 2 Proper management of hypertension is essential in both the short term and long term after pediatric heart transplantation. In the immediate post-transplant period, it is recommended that systemic hypertension be controlled in order to minimize afterload and strain on the newly transplanted LV.…”

“…3 Chronically, post-transplant hypertension can lead to increased arterial stiffness which can result in cardiovascular events and graft vascular disease. 2,4 While hypertension is relatively common, the risk factors for its development are not well described, particularly in the days, weeks, and months immediately following transplant. The majority of existing pediatric studies focus on hypertension persisting years after transplant, with association found between chronic hypertension and the immunosuppressive regimen.…”

“…The incidence of hypertension has been shown to peak 5 days after transplant 1 and often requires the use of anti‐hypertensive infusions in the ICU. Hypertension following transplant is associated with increased cardiovascular morbidity and mortality 2 . Proper management of hypertension is essential in both the short term and long term after pediatric heart transplantation.…”

“…In the immediate post‐transplant period, it is recommended that systemic hypertension be controlled in order to minimize afterload and strain on the newly transplanted LV 3 . Chronically, post‐transplant hypertension can lead to increased arterial stiffness which can result in cardiovascular events and graft vascular disease 2,4 …”