TITLE

THE EFFICACY OF ANTIHYPERTENSIVE AGENTS AFTER LIVER TRANSPLANT AND THEIR EFFECT UPON ARTERIAL STIFFNESS

AUTHOR(S)
Neal, D.A.J.; Brown, M.J.; Wilkinson, I.B.; Alexander, G.J.M.
PUB. DATE
April 2003
SOURCE
Gut;Apr2003 Supplement 1, Vol. 52, pA103
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Background: Hypertension develops in over 50% of patients after liver transplant. Arterial stiffness is an important measure of cardiovascular risk. Augmentation index (Al) is a reflection of arterial stiffness and can be determined by pulse wave analysis of the radial artery. Methods: 21 hypertensive liver transplant recipients were commenced on the calcium channel blocker amlodipine. 8 patients who were intolerant of or unresponsive to amlodipine were administered the beta-adrenoceptor antagonist bisoprolol and the angiotensin converting enzyme inhibitor lisinopril in a crossover study. Systolic blood pressure (BP) and Al were measured before and after a median of 10 weeks on each drug. Al is expressed as a percentage of the central pulse pressure. No patient received any additional antihypertensive therapy including diuretics. Results: Al fell from 24 ± 2% to 16 ± 2% (p < 0.001) with amlodipine while BP fell from 156 ± 2 to 133 ± 2 mm Hg (p < 0.001). Al increased from 17 ± 5% to 26 ± 3% (p = 0.015) with bisoprolol while BP fell from 158 ± 5 to 142 ± 3 mm Hg (p = 0.019). In contrast, lisinopril reduced Al From 20 ± 2% to 13 ± 3% (p = 0.021) and BP fell from 156 ± 2 to 133 ± 5 mm Hg (p = 0.003). 40% experienced lower limb oedema with amlodipine. Bisoprolol and lisinopril were both well tolerated. Creatinine clearance was unchanged after treatment with lisinopril. Discussion: Amlodipine reduces BP and Al but Iow doses are required in view of the frequency of leg oedema. The choice of bisoprolol or lisinopril as second line treatment is influenced by the differing effects on augmentation index. The increase in Al with bisoprolol implies that central aortic pressure is not reduced as much as appears from the observed reduction in peripheral BP. Lisinopril, by reducing Al and arterial stiffness, may therefore be preferred to bisoprolol. The long term effects of these drugs upon...
ACCESSION #
9747990

 

Related Articles

  • Portopulmonary hypertension. Sarfraz Saleemi // Annals of Thoracic Medicine;Jan-Mar2010, Vol. 5 Issue 1, p5 

    Portopulmoanry hypertension (POPH) is a form of pulmonary arterial hypertension (PAH) associated with portal hypertension with or without underlying chronic liver disease. POPH is increasingly recognized and recent evidence suggests that it is one of the leading causes of PAH. The...

  • EDITOR'S MEMO. Park, Myung H. // Advances in Pulmonary Hypertension;Summer2013, Vol. 12 Issue 2, p50 

    The author comments on the challenges in kidney or liver transplant and pulmonary hypertension.

  • Multidetector computed tomography hepatic findings in children with end-stage biliary atresia. Caruso, Settimo; Miraglia, Roberto; Milazzo, Mariapina; Maruzzelli, Luigi; Pasta, Armando; Spada, Marco; Riva, Silvia; Luca, Angelo; Gridelli, Bruno // European Radiology;Jun2010, Vol. 20 Issue 6, p1468 

    To illustrate the multidetector computed tomography (MDCT) findings in patients with end-stage biliary atresia (BA). The study group consists of 45 consecutive patients with BA who underwent MDCT before liver transplantation from February 2005 to February 2008. Mean age was 36 months, 24...

  • Transjugular Intrahepatic Portosystemic Shunt with Thrombectomy for the Treatment of Portal Vein Thrombosis After Liver Transplantation. Lodhia, Nilesh; Salem, Riad; Levitsky, Josh // Digestive Diseases & Sciences;Feb2010, Vol. 55 Issue 2, p529 

    The article presents a case study on the techniques of treating portal vein thrombosis (PVT) after liver transplantation. It suggests that therapeutic anticoagulation can result in partial recanalization of the portal vein in the majority of patients being treated. It notes that PVT often occur...

  • Cardiovascular Changes in Cirrhosis: Pathogenesis and Clinical Implications. Al-hamoudi, Waleed K. // Saudi Journal of Gastroenterology;Jul2010, Vol. 16 Issue 3, p145 

    Liver cirrhosis is associated with a wide range of cardiovascular abnormalities including hyperdynamic circulation, cirrhotic cardiomyopathy, and pulmonary vascular abnormalities. The pathogenic mechanisms of these cardiovascular changes are multifactorial and include neurohumoral and vascular...

  • Polymorphisms in the methylenetetrahydrofolate reductase gene are determinant for vascular complications after liver transplantation. Akoglu, B.; Kindl, P.; Weber, N.; Trojan, J.; Caspary, W. F.; Faust, D. // European Journal of Clinical Nutrition;Mar2008, Vol. 62 Issue 3, p430 

    Objective:The aim of this study was to evaluate the role of the C677T-MTHFR (methylenetetrahydrofolate reductase)-polymorphism (CC, CT and TT) for vascular complications in liver transplant recipients.Design:Retrospective study.Setting:Hepatology-Transplantation-Unit, Johann Wolfgang...

  • Transjugular Intrahepatic Portosystemic Shunt for Maintenance of Portal Venous Patency in Liver Transplant Candidates. Gaba, Ron Charles; Parvinian, Ahmad // Journal of Clinical Imaging Science;Jan-Mar2013, Vol. 3 Issue 1, p1 

    Maintenance of portal venous patency is vital to liver transplant candidates, as the presence of portal vein thrombosis (PVT) adversely impacts clinical outcomes by increasing surgical complexity and decreasing postoperative survival. By enhancing portal venous blood flow, transjugular...

  • Management of complications after varicoportal anastomosis in liver transplantation. Kniepeiss, Daniela; Müller, Helmut; Wagner, Doris; Iberer, Florian; Tscheliessnigg, Karl-Heinz // Wiener Klinische Wochenschrift;Jun2011, Vol. 123 Issue 11/12, p388 

    The presence of portal vein thrombosis is a potential limitation for liver transplantation. An intraoperative diagnosis is linked to extensive surgical treatment and massive postoperative complications and mortality. We present a surgical less risky method for the treatment of intraoperatively...

  • Aprotinin.  // Reactions Weekly;3/20/2004, Issue 993, p6 

    Discusses research being done on the implication of aprotinin on intravascular thrombosis and thromboembolism during liver transplantation. Reference to a study by M. A. E. Ramsay, H. B. Randall and E. C. Burton published in a February 2004 issue of "Liver Transplantation"; Case of a man who...

Share

Read the Article

Courtesy of VIRGINIA BEACH PUBLIC LIBRARY AND SYSTEM

Sign out of this library

Other Topics