Hypertension after heart transplantation

Transplantations of the heart are in recent years the therapeutic method in severe cardiac failure. One of the complications in the long-term follow-up of patients is the development of hypertension. The incidence of hypertension in patients treated with cyclosporin and prednisone is 70-90%. In the development of hypertension participates in addition to classical mechanisms (renin angiotensin system, fluid volume and peripheral resistance) also the negative effect of cardiac denervation, cyclosporin immunosuppression, corticoids and nephropathy. The nocturnal drop of pressure and pulse rate is lacking. Mechanisms of cyclosporin induced hypertension:enhancement of the vasoconstricting effect of endothelin 1, reduced NO production, activation of neurohumoral vasoconstrictors, increased calcium level in cytosols, increased thromboxane A production, reduced production of vasodilatating prostaglandins and activation of the sympathicus. The prerequisite of treatment are efforts to maintain the lowest possible effective cyclosporin level and if possible discontinue corticoids during the first year. The drug of first choice are calcium antagonists among others for their preventive effect on the vasculopathy of the graft. Other recommended groups of drugs are ACE inhibitors and diuretics.