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.
Highlights
Heart transplantation is indicated for the treatment of heart failure refractory to clinical, surgical and interventional treatments
After analyzing the patients’ comorbidities and the impacts of diabetes, hypertension, peripheral artery disease and coronary heart disease, it was found that all of these factors are significantly related to arterial stiffness (20.8%, 50%, 7.9%, and 46.1% if stiffness was present in a patient versus 3.4%, 20.3%, 0, and 16.1% if not)
’ DISCUSSION In recent years, arterial stiffness has been shown to be an important marker of cardiovascular events and cerebrovascular accidents (CVA) in the general population, especially in patients with chronic kidney disease or diabetes [15,22]
Summary
Heart transplantation is indicated for the treatment of heart failure refractory to clinical, surgical and interventional treatments. Transplantation survival has improved significantly in recent decades, mainly due to the emergence of new immunosuppressants [1], which have promoted greater graft survival [2]. Post-transplantation hypertension is a major cardiovascular problem. The vasoconstrictor effect of immunosuppressants, including cyclosporin, plays an important role in generating this hypertension [1,2,3]. Denervation and the consequent increase in heart rate have important implications for exercise, arterial stiffness, graft vascular disease (GVD), acute rejection and other clinical parameters [4,5].
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