117Arterial hypertension after heart transplantation: prevalence, predictors and prognostic impact. Single centre prospective study

Abstract

Objectives: The study was aimed to assess arterial hypertension (AH) prevalence, risk factors, and its impact on event-free survival among cardiac transplant recipients. Patients and methods: End-stage heart failure patients who received a heart transplant (HTx) between 01.01.2013 and 31.12.2016 in National Research Centre of Transplantology and Artificial Organs and survived 90 days were sequentially included and followed-up for 1556.2±42.9 (95% CI= 1472.1-1640.2) days. Young patients (<18 y/o) and patients after repeated or multi-organ transplantation were excluded. 140 mm Hg of systolic and 90 mm Hg of diastolic blood pressure (BP) levels were assumed as cut-off levels for the diagnosis and therapeutical target for AH treatment. All-cause death, irreversible cardiac transplant failure and any coronary event (acute coronary syndromes or revascularization) were defined as primary endpoints. Results: 353 cardiac recipients aged 45.6±1.6 years (18.1% females and 81.9% males) enrolled in the study. AH prevalence was 17.6% in anamnesis and 42.8%, 62.3%, and 71.4% after 3 months, 1 year, and 3+ years, respectively, in post-transplant period. The risk of developing post-transplant AH 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 antibodymediated rejection episodes (OP=1.7, p=0.001). BP reached target levels during 18±11 days in all patients after diuretics, ACEi, or calcium antagonists (CA) were administered in monotherapy or combination. There were 82 primary events during follow-up. When patients who developed AH during the first 90 days after HTx (n=151) and those who did not (n=202) were compared, no significant difference in event-free survival was found (RR=1.21, 95% CI - 0.83-1.77). Hypertensive patients who received ACEi (n=113) showed significantly better survival when compared to those who received CA (RR=0.52, 95% CI=0.28-0.98). ACEi and CA subgroups comparison revealed significant differences in systolic BP (123.8±8.5 vs 130.0±9.4 mmHg, respectively, p<0.001), diastolic BP (77.5±6.0 vs 82.6±7.7 mmHg, p<0.001, respectively) and mean LV EF (67.7±6.2% vs 62.6±7.4%, respectively, p<0.001). Conclusions: This single-centre study which included 59.7% of patients who received cardiac transplants in Russia in 2013-2016 showed the high prevalence of AH. Anamnestic hypertension, renal failure, donors heart hypertrophy and antibody-mediated transplant rejection were related to the development of post-transplant AH. Well-controlled AH had no impact on prognosis, but ACEi were related to better event-free survival than calcium antagonists. Several mechanisms could be proposed.