SEX DIFFERENCES IN THE INCIDENCE OF ARTERIAL HYPERTENSION FOLLOWING HEART TRANSPLANTATION

Abstract

Objective: Arterial hypertension (AH) is a common complication in heart transplant (HTX) recipients affecting 50-80% of patients (pts). The aim of our study was to evaluate sex differences in the incidence of AH in HTX pts. Design and method: We retrospectively analyzed pts who underwent HTX in our center between 01/2010 and 12/2020. Results: We enrolled a total of 164 pts with a survival of more than 1 year after HTx. The study group included 126 males, average age of 50,5 ± 10,8 years, and 38 females average age of 46,4 ± 10,2 years. All pts after HTX received standard immunosuppressive treatment according to the protocol of our center, including calcineurin inhibitors. Pre-transplant AH was present in 35% (n = 58 pts). Pre-transplant - AH was more prevalent in males 41% (n = 52 pts) compared to females 16% (n = 6 pts). Prevalence of AH after HTx was 68% (n = 112) pts, more frequent in males 71% (n = 90) vs females 58% (n = 22). The average BP in the medical record 1 year after HTX was 136 ±14/ 84 ± 10 mmHg. All 112 pts with post-transplant AH were treated with AH treatment: 52% (n = 58) were treated with monotherapy, 35% (n = 39) with two-drug combinations, 10% (n = 11) with three-drug combinations, and 3% (n = 4) with four-drug combinations. The most frequently used AH drugs were calcium channel blockers in 54% (n = 60) pts, followed by ACE inhibitors in 46% (n = 52) and beta-blockers in 34% (n = 38). As independent risk factors for developing post-transplant AH in both groups were identified presence pre- transplant AH ( RR 1,5; CI 2,27 – 13,17), hypertriglyceridemia (RR 1,6 ; CI 1,75 – 16,24) and pre-transplant ischemic cardiomyopathy ( RR 1,4 ; CI 1,41 – 7,68). Conclusions: AH 1 year after HTx is a common complication. In our group of pts affected 68% of pts. We observed a greater increase in the incidence of post-transplant vs pre-transplant AH in females pts. Patients with pre-transplant AH, elevated triacylglycerides, and ischemic cardiomyopathy, are at high risk to develop post-transplant AH. Therefore they require more consistent follow-up even in the early period after HTX.