Predictors of Hypertension Development 1 Year After Heart Transplantation.
Predictors of Hypertension Development 1 Year After Heart Transplantation.
复制标题
心脏移植后一年高血压发生的预测因素。
DOI：
10.1097/tp.0000000000004068
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发表时间：
2022
期刊：
影响因子：
6.2
通讯作者：
Wyller,VegardBB
中科院分区：
文献类型：
--
作者：
Nygaard,Sissel;Christensen,AndersH;Sletner,Line;Rolid,Katrine;Nytrøen,Kari;Gullestad,Lars;Fiane,Arnt;Thaulow,Erik;Døhlen,Gaute;Saul,JPhilip;Wyller,VegardBB
背景：心脏移植后高血压是常见的。我们调查了HTx后第一年高血压发展的预测因素和机制，特别注意免疫抑制剂，神经再支配过程，和供体/受体sex.Methods。心脏移植受者（HTxRs）连续登记7至12周手术后，前瞻性随访12个月。在基线和随访时进行动态血压记录和自主心血管控制评估。结果：共纳入50例移植后高血压患者，47例患者在术后12个月接受随访。在观察期间，平均收缩压和舒张压显著升高（收缩压从133至139 mm Hg，P= 0.007;舒张压从81至84 mm Hg，P= 0.005）。血压升高几乎仅限于女性供体心脏的HTxR，在该亚组中，收缩期高血压病例（从6例增加到13/14例; 46%增加到93%，P= 0.031）和舒张期高血压病例（从7例增加到14/14例; 54%增加到100%，P= 0.031）增加了一倍。自主心血管控制评估表明，在女性供体心脏的受体中，血管阻力和电容紧张性收缩。免疫抑制剂和神经再支配标记物与高血压的发展无关。结论：HTx后的第一年血压增加，女性供体性别是受体高血压发展的一个强有力的预测因素。潜在的机制似乎是由减弱的心血管稳态能力引起的外周血管收缩增强。需要进一步的研究来证实结果。
Background.Hypertension after heart transplantation (HTx) is common. We investigated predictors of and mechanisms for hypertension development during the first year after HTx, with particular attention toward immunosuppressive agents, reinnervation processes, and donor/recipient sex.Methods.Heart transplant recipients (HTxRs) were consecutively enrolled 7 to 12 wk after surgery and followed prospectively for 12 mo. Ambulatory blood pressure recordings and autonomic cardiovascular control assessments were performed at baseline and follow-up. Possible predictors of posttransplant hypertension development were investigated in bivariate linear regression analyses followed by multiple regression modeling.Results.A total of 50 HTxRs were included; 47 attended the follow-up appointment at 12 mo. Mean systolic and diastolic blood pressure increased significantly during the observational period (systolic blood pressure from 133 to 139 mm Hg, P= 0.007; diastolic blood pressure from 81 to 84 mm Hg, P= 0.005). The blood pressure increment was almost exclusively confined to HTxRs with a female donor heart, doubling the cases of systolic hypertension (from 6 to 13/14; 46% to 93%, P= 0.031) and diastolic hypertension (from 7 to 14/14; 54% to 100%, P= 0.031) in this subgroup. Autonomic cardiovascular control assessments suggested tonically constricted resistance and capacitance vessels in recipients with female donor hearts. Immunosuppressive agents and reinnervation markers were not associated with hypertension development.Conclusions.Blood pressures increase during the first year after HTx, with female donor sex as a strong predictor of recipient hypertension development. The underlying mechanism seems to be enhanced peripheral vasoconstriction caused by attenuated cardiovascular homeostasis capabilities. Further studies are needed to confirm the results.