The authors looked at 77 patients following orthotopic heart transplant who received a triple immunosuppressive regimen including cyclosporine to see the effect of various antihypertensive medications on mean arterial blood pressure and renal function. There were 62 men and 15 women retrospectively classified into three groups according to the antihypertensive medications they received. Group 1 included 26 patients followed up for 10.7 ± 2.7 months who received hydralazine therapy. Group 2 included 32 patients followed up for 9.0 ± 3.4 months who received angiotensin-converting enzyme inhibition therapy. Group 3 included 19 patients followed up for 10.1 ± 3.3 months who received beta- adrenergic blocking agents. Mean arterial pressure (MAP), serum blood urea nitrogen (BUN), and serum creatinine (CR) were determined for each group at the start and end of the follow-up period. The MAP at the start of the study was 107 ± 14 in group 1,110 ± 13 in group 2, and 100 ± 11 in group 3. It was not statistically significantly different in any of the groups.
At the end of the follow-up period, MAP was 112 ± 10, 111 ± 10, and 106 ± 12 for the three groups respectively, and it was not significantly different in any group. The serum BUN in group 3 was 25 ± 8 mg/dL at the start of the study, and it was not significantly lower than that in group 1, 28 ± 6, but it was significantly different from that in group 2, 34 ± 9, P < 0.05. At the end of the follow-up period, the difference was still maintained. Moreover, it was signifi cantly different also from the BUN of group 1. The serum CR was 1.16 ± 0.25 at the start in group 3, and it was not significantly lower than that of either group 1 (1.27 ± 0.25) or group 2 (1.38 ± 0.37). There was a significant rise of serum CR levels in all groups over the duration of the follow-up (P < 0.05) re gardless of the antihypertensive therapy they received, however, CR of group 3 was significantly lower than that of groups 1 and 2 at the end of the follow-up.
The authors conclude that hypertension that develops after heart transplant is not easily controlled by medications. The deterioration in renal function over time is not related to the height of arterial blood pressure or to the antihyperten sive medications used.
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