ARTERIAL HYPERTENSION IN PATIENTS LONG TERM AFTER LIVER TRANSPLANTATION

Objective: Cardiovascular diseases are one of the most frequent causes of death of patients after liver transplantation (LTx). The aim of this retrospective clinical study was to estimate the prevalence of arterial hypertension among patients after successful LTx. Design and method: Two hundred forty three patients, aged 49.5±11.7 years (91 women, 152 men) after successful LTx who completed 24 months follow-up were studied. Diagnosis of hypertension was based on the following criteria: office blood pressure equal or higher thab 140/90 mmHg during two separate visit or use of antihypertensive pharmacotherapy. Results are presented as means with standard deviation. Results: The prevalence of hypertension in patients before LTx was 28.8%. Twenty four months after LTx the prevalence of hypertension increased significantly to 67.5% (p<0.001, Q Cochrane test). Therefore, annual incidence for arterial hypertension during 24 months after LTx was 18.5%. Systolic and diastolic blood pressure 24 months after LTx were 135.3 ± 18.1, and 86.4 ± 10.7 mmHg, respectively. Number of patients treated with immunosuppressive regimen based on tacrolimus or cyclosporine A or everolimus were 204 (84%), 22 (9%) and 17 (7%), respectively. Prevalence of arterial hypertension in patients treated with immunosuppressive regimen based on tacrolimus, cyclosporine A or everolimus was 63.7%, 86.4% and 88.2% respectively (p=0.01; tacrolimus vs cyclosporine p=0.03; tacrolimus vs everolimus p=0.04). Patients with arterial hypertension were treated with 1.7 ± 1.2 antihypertensive drugs. Beta-adrenergic antagonists were used by 52.2%, calcium channel antagonists by 40.9%, diuretics by 32.1%, angiotensin converting enzyme inhibitors by 28.3%, angiotensin 2 receptor antagonists 8.2% and alfa-adrenergic antagonists by 6.3% patients with arterial hypertension. Conclusions: 1. Arterial hypertension occurs in nearly 70% of patients long term after LTx. 2. Immunosuppressive regimen might influence the prevalence of arterial hypertension in liver transplant recipients. 3. High prevalence of arterial hypertension in patients after LTx needs special attention and specific treatment in order to reduce increased cardiovascular morbidity and mortality observed in these patients.