Incidence and Treatment of Arterial Hypertension After Heart Transplantation

Abstract

<h3>Purpose</h3> Arterial hypertension is a common comorbidity among heart transplant (HT) recipients. Post-HT hypertension (HTN) can contribute to graft dysfunction and has been associated with the development of cardiac allograft vasculopathy. However, the risk factors for and optimal management of post-HT HTN is not completely understood. <h3>Methods</h3> Retrospective review of electronic medical records for patients undergoing HT at a large academic center between 1/2010 and 12/2017 was performed. Patients undergoing repeat HT were excluded from the analysis. HTN was defined by clinician documentation in the medical record and treatment with anti-hypertensive agents. <h3>Results</h3> 280 HT patients were identified with a median follow-up of 5.1 (IQR 2.6-8.1) years. 128 (45.7%) had pre-transplant HTN and 198 (70.7%) patients had post-transplant HTN. Among the 152 patients without pre-transplant HTN, 81 (53.3 %) were diagnosed with new-onset HTN during a median follow-up of 6.3 (IQR 3.5-9.0) years. Median age of those with new-onset HTN was 54 (IQR 44-64) years, 21.0% were female, and 18.5% had ischemic cardiomyopathy. In multivariable analyses, male sex was associated with new-onset post-HT HTN (HR 2.52, CI 1.19-5.48, p=0.02, <b>Table 1a</b>). Among the 198 patients with post-transplant HTN, 84.2% were treated with a beta blocker, 52.0% with a potassium-sparing diuretic, and 51.0% with an ACE inhibitor or angiotensin II receptor blocker during follow-up (<b>Table 1b</b>). <h3>Conclusion</h3> Arterial HTN is a common complication of HT, affecting over 70% of our cohort. Males may be at higher risk for developing new-onset HTN post-HT. Further studies are required to determine the optimal medical therapy for this select cohort of patients with hypertension.