The Clinical Impact of ACEI/ARBs in Heart Transplantation: Perhaps Not All Good

Chang, D.; Kittleson, M.; Patel, N.; Singer-Englar, T.; Ackerman, Marra; Patel, Jignesh; Geft, D.; Hamilton, Michèle A.; Czer, L.; Trento, Alfredo; Kobashigawa, J.A.

doi:10.1016/j.healun.2021.01.808

Cited by 1 publication

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“…Additionally, a recent single-center study by Henricksen et al [18 ▪▪ ] suggested ACEi and ARB therapies could be safely used in heart transplant patients with preserved renal function within the first year with close monitoring of renal function as a third of patients eventually discontinued therapy, mainly due to worsening renal function and hyperkalemia. In contrast, another study by Chang et al [19 ▪▪ ] that included 101 heart transplant patients treated with ACEI/ARBs in the first year post-heart transplant found significantly lower 5-year survival but a trend for greater 5-year freedom from cardiac allograft vasculopathy (CAV) when compared to heart transplant patients not treated with an ACEi/ARB. Additionally, 5-year freedom from nonfatal major cardiac adverse events including left ventricular dysfunction and LVH were similar between the 2 groups [19 ▪▪ ].…”

Section: Pharmacological Therapy For Blood Pressure Control In Heart ...mentioning

confidence: 93%

“…In contrast, another study by Chang et al [19 ▪▪ ] that included 101 heart transplant patients treated with ACEI/ARBs in the first year post-heart transplant found significantly lower 5-year survival but a trend for greater 5-year freedom from cardiac allograft vasculopathy (CAV) when compared to heart transplant patients not treated with an ACEi/ARB. Additionally, 5-year freedom from nonfatal major cardiac adverse events including left ventricular dysfunction and LVH were similar between the 2 groups [19 ▪▪ ].…”

Section: Pharmacological Therapy For Blood Pressure Control In Heart ...mentioning

confidence: 93%

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Management of hypertension in heart transplant recipients: an ongoing conundrum

Torres,

Krim

2024

Current Opinion in Cardiology

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Purpose of review Hypertension remains one of the most common clinical problems leading to significant posttransplant complications. This study reviews the pathophysiology of hypertension in the postcardiac transplant phase and provides an update on currently available antihypertensive therapies for heart transplant patients. Recent findings The true prevalence of hypertension in the heart transplant population remains unknown. Effective blood pressure (BP) control is key to prevent left ventricular remodeling, diastolic dysfunction and stroke. Calcium channel blockers (CCBs) are the most commonly and preferred agents in the early posttransplant phase and may have renal protective effects. Angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs) can all be used as second line antihypertensive agents and may have a role in preventing other long-term complications such as calcineurin-inhibitor induced nephropathy. Although more data are needed, sodium-glucose co-transporter 2 inhibitors (SGLT2i) appeared to be well tolerated and could be considered especially in the presence of type diabetes and chronic kidney disease. Conversely, angiotensin receptor-neprilysin inhibition (ARNI) have not been studied in the heart transplant population therefore cannot be recommended at this time. Summary Hypertension is very common after heart transplant. Early steroid wean and traditional risk factor modification play an important part in the management of post-heart transplant hypertension. CCB, ACEI, ARB are the preferred antihypertensive agents to improve postcardiac transplant complications. Novel therapies such as SGLT2i appear well tolerated and may have benefits in both BP and glycemic control in heart transplant; however, larger trials are needed.

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Section: Pharmacological Therapy For Blood Pressure Control In Heart ...mentioning

confidence: 93%

Section: Pharmacological Therapy For Blood Pressure Control In Heart ...mentioning

confidence: 93%