Hypertension after pediatric cardiac transplantation: Detection, etiology, implications and management

S. Lucy Roche; John O’Sullivan; Paul F. Kantor

doi:10.1111/j.1399-3046.2009.01205.x

July 16, 2009Pediatric Transplantation

Hypertension after pediatric cardiac transplantation: Detection, etiology, implications and management

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Structured PICO

P

Population

Pediatric cardiac transplant recipients

I

Intervention

Blood pressure monitoring (including 24 h-ABP) and antihypertensive treatment

This review highlights that 50-70% of pediatric cardiac transplant recipients develop new-onset hypertension and discusses optimal monitoring and management strategies.

Implication

Requires close hypertension monitoring after pediatric heart transplant; leaves optimal management strategies open for prospective study.

Abstract

Roche SL, O’Sullivan JJ, Kantor PF. Hypertension after pediatric cardiac transplantation: Detection, etiology, implications and management. Pediatr Transplantation 2010:14: 159–168. © 2009 Wiley Periodicals, Inc. Abstract: While it may rescue children with end-stage heart failure from impending catastrophe, cardiac transplantation leaves 50–70% of pediatric recipients with new-onset hypertension. Given the unique vulnerability of the heart and kidneys in these children, we can expect long-term uncontrolled hypertension to shorten both graft and patient survival. In this review we discuss the multi-factorial etiology of post-transplant hypertension, highlighting current uncertainties and emphasizing mechanisms specific to cardiac recipients. We consider the optimal means of monitoring BP and in particular, the advantages of 24 h-ABP over intermittent clinic measurements. We also review BP treatment after cardiac transplantation, drawing attention to specific cautions appropriate when prescribing antihypertensive agents in these circumstances.