Prevalence and Predictors of Hypertension among Heart Transplant Recipients: An Analysis of Russian National Medical Research Centre of Transplantology and Artificial Organs registry

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Abstract

Introduction

Post-transplant arterial hypertension (AH) is an important modifiable risk factor for the development of cardiovascular events and renal dysfunction.

Objectives

The study was aimed to assess prevalence and risk factors for the development of AH in heart transplant recipients.

Patients and Methods

End-stage heart failure patients who received cardiac transplant between 01.01.2013 and 31.12.2016 in the Russian National Research Centre of Transplantology and Artificial Organs (Moscow) and survived 3 months were included and followed-up for 999.4±774.3 (108-1587) days. Young patients (<18 y/o) and patients after repeated (n=18) or multi-organ transplantation (n=3) were excluded.

Results

353 cardiac recipients aged 45.6±1.6 years (64 females and 289 males) were enrolled to the study. AH prevalence was 17.6%, 42.8%, 62.3%, and 71.4% in the pre-transpalnt anamnesis, 3 months, 1 year, and 3+ years after the transplantation, respectively. The risk of developing post-transplant hypertension was independent of age, sex, initial diagnosis, mean tacrolimus levels and the number of acute cellular rejections. Post-transplant AH was significantly related to the initial body mass index (p=0.026), serum creatinine (p<0.001), preexisting hypertension (RR=1.36, p=0.022) and renal failure, as well as donor heart posterior wall thickness (p=0.034), post-transplant dialysis (RR=1.85, p<0.001), and antibody mediated rejection episodes (OP=1.7, p=0.001).

Conclusions

Hypertension is highly prevalent among our population of cardiac recipients. Combination of various etiologic mechanisms, multiplex therapy and subjective factors demand the careful individual patient management. Controlled clinical trials are required to determine target blood pressure levels and assess the impact of various antihypertensive medications on long-term prognosis.

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