心脏移植受者的高血压管理:一个持续的难题。

IF 2 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
Current Opinion in Cardiology Pub Date : 2024-07-01 Epub Date: 2024-03-27 DOI:10.1097/HCO.0000000000001145
Juan Duarte Torres, Selim R Krim
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引用次数: 0

摘要

审查目的:高血压仍然是导致移植后严重并发症的最常见临床问题之一。本研究回顾了心脏移植术后阶段高血压的病理生理学,并提供了目前针对心脏移植患者的降压疗法的最新进展:最近的研究结果:心脏移植人群中高血压的真实发病率仍然未知。有效控制血压是预防左心室重塑、舒张功能障碍和中风的关键。钙通道阻滞剂(CCB)是移植后早期最常用和首选的药物,可能具有肾脏保护作用。血管紧张素转换酶抑制剂(ACEIs)、血管紧张素受体阻滞剂(ARBs)均可作为二线降压药物,并可能在预防其他长期并发症(如钙神经蛋白抑制剂诱发的肾病)方面发挥作用。钠-葡萄糖协同转运体 2 抑制剂(SGLT2i)似乎耐受性良好,尤其是在糖尿病和慢性肾病患者中可以考虑使用,但还需要更多的数据。相反,血管紧张素受体-去甲肾上腺素抑制剂(ARNI)尚未在心脏移植人群中进行过研究,因此目前还不能推荐使用。在心脏移植术后高血压的治疗中,早期停用类固醇和改变传统的危险因素非常重要。CCB、ACEI、ARB 是改善心脏移植术后并发症的首选降压药物。SGLT2i等新型疗法似乎耐受性良好,可能对心脏移植术后的血压和血糖控制都有益处;但还需要进行更大规模的试验。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Management of hypertension in heart transplant recipients: an ongoing conundrum.

Purpose of review: Hypertension remains one of the most common clinical problems leading to significant posttransplant complications. This study reviews the pathophysiology of hypertension in the postcardiac transplant phase and provides an update on currently available antihypertensive therapies for heart transplant patients.

Recent findings: The true prevalence of hypertension in the heart transplant population remains unknown. Effective blood pressure (BP) control is key to prevent left ventricular remodeling, diastolic dysfunction and stroke. Calcium channel blockers (CCBs) are the most commonly and preferred agents in the early posttransplant phase and may have renal protective effects. Angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs) can all be used as second line antihypertensive agents and may have a role in preventing other long-term complications such as calcineurin-inhibitor induced nephropathy. Although more data are needed, sodium-glucose co-transporter 2 inhibitors (SGLT2i) appeared to be well tolerated and could be considered especially in the presence of type diabetes and chronic kidney disease. Conversely, angiotensin receptor-neprilysin inhibition (ARNI) have not been studied in the heart transplant population therefore cannot be recommended at this time.

Summary: Hypertension is very common after heart transplant. Early steroid wean and traditional risk factor modification play an important part in the management of post-heart transplant hypertension. CCB, ACEI, ARB are the preferred antihypertensive agents to improve postcardiac transplant complications. Novel therapies such as SGLT2i appear well tolerated and may have benefits in both BP and glycemic control in heart transplant; however, larger trials are needed.

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来源期刊
Current Opinion in Cardiology
Current Opinion in Cardiology 医学-心血管系统
CiteScore
4.20
自引率
4.30%
发文量
78
审稿时长
6-12 weeks
期刊介绍: ​​​​​​Current Opinion in Cardiology is a bimonthly publication offering a unique and wide ranging perspective on the key developments in the field. Each issue features hand-picked review articles from our team of expert editors. With fourteen disciplines published across the year – including arrhythmias, molecular genetics, HDL cholesterol and clinical trials – every issue also contains annotated reference detailing the merits of the most important papers.
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