Hypertension and renal transplantation

Hippokratia 2001, 5 (2): 51-60

G. Vergoulas

Abstract

Hypertension after renal transplantation contributes significantly to the cardiovascular death of adults and children. Initially there was a debate about the effect of hypertension on renal graft survival. Recently, however, it has been proved that there is a significantly negative correlation between the levels of systolic and diastolic arterial blood pressure and the long term graft survival6. The negative effect of systolic blood pressure was present even if the diastolic blood pressure was less than 90 mmHg. The prevalence of hypertension is 75-80 % among renal transplant recipients in the immediate post transplant period in the cyclosporine era, while in the precyclosporine era it was 45-50%. The factors causing hypertension after renal transplantation can be discriminated in graft endogenous and exogenous. Hypertension of renal graft recipients is multifactorial and usually these patients have more than one cause of hypertension . During the immediate post transplant period, the positive balance of sodium and water, the acute tubular necrosis, the acute obstruction of the ureter, the acute rejection and the hypercalcemia9 have been incriminated as causes of hypertension. Hypertension after the first transplant trimester is related to corticosteroid, cyclosporine and FK506 use as well as chronic allograft rejection.

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The use of Valsartan in hypertensive renal transplant recipients

Hippokratia 2001, 5 (2): 61-68

G Vergoulas, Gr Miserlis, D Gakis, E Atmatzidis, A Antoniadis

Abstract

The aim of this study was to investigate the efficacy and safety of valsartan in the treatment of hypertension in patients with renal transplantation. Twenty three patients (18 men) on therapy with antihypertensive drugs were included in the study because of insufficient control of their blood pressure and/or drug side effects. These patients received valsartan at the dose of 80-160 mg/d. All patients in the study had serum creatinine level < 2.0 mg/dl before treatment with valsartan and a follow up six months before and six months after treatment. Systolic (SBP) and diastolic blood pressure (DBP), serum creatinine (Scr), Ht, Hb, uric acid and potassium were recorded every two months for a period of six months before (BVT) and six months after initiation of valsartan treatment (AVT). Proteinuria, number of antihypertensive agents, cyclosporine (CsA) dose and levels were recorded BVT (time 0) and six months later. Two patients stopped valsartan treatment because of serum creatinine elevation. ANOVA for repeated measures and paired t test were used for statistical analysis.SBP/DBP was 142.63+12.51/89.47±8.48 mmHg, 142.63±17.74/88.42±6.67 mm Hg, 144.47±11.53/ 92.63 ± 8.22 mmHg, 151.05±11.37/89.47±7.61 mmHg 6, 4, 2 and 0 months BVT respectively (p=NS) and 142.00±9.92/85.25±6.78 mmHg, 137.25±10.93/85.75±6.72 mmHg and 133.25±8.92/84.00±5.92 mmHg 2, 4 and 6 months AVT respectively (p=0.0001 for SBP). The number of antihypertensive agents per patient was 2.09±0.83/1.47±0.60 (p=0.001) at time 0 and six months after valsartan initiation. Scr was 1.30±0.34 mg/dl, 1.29±0.32 mg/dl, 1.31±0.33 mg/dl and 1.28+0.33 mg/dl 6, 4, 2 and 0 months BVT, respectively (p=NS) and 1.36±0.36 mg/dl, 1.40±0.37 mg/dl and 1,34±0.32 mg/dl 2, 4 and 6 months AVT initiation respectively (p=0.036). Ht/Hb were 40.47±6.26%/13.13±2.07g/dl, 40.78±6.39% /13.01±2.03g/dl, 4l.21±5.98% /13.22 ±2.01g/dl,41.77±6.04%/ 13.32 ± 2.02 g/dl 6, 4, 2 and 0 months BVT respectively (p=NS) and 38.65±6.10% / 12.65 ±1.93 g/dl, 38.65+6.10%/ 12.51±2.01 g/dl, 38.10+5.77%/12.55±2.10g/dl at 2, 4 and 6 months AVT initiation, respectively (p=0.001/ 0.022 respectively).In conclusion Valsartan offers a better control of blood pressure in patients with renal transplantation, lowers significantly the number of antihypertensive agents needed, causes a significant fall of Ht/Hb and a small but significant rise of serum creatinine level.

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Hypertensive acute heart failure and elevated glucose levels

Hippokratia 2001, 5 (2): 69-75

D Psirropoulos, N Lefkos, G Boudonas, Ap Efthimiadis, G Tsapas

Abstract

The role of hypertension and diabetes mellitus as risk factors in coronary heart disease is known but the role of elevated glucose levels in patients who are apparently non-diabetic but suffering from hypertensive heart failure is controversial.
Methods: Sixty eight hypertensive patients under sufficient anti-hypertensive treatment (M=42, F=26, mean age=70+8 years) with heart failure (II-IV NYHA class, EFΘ40%, LAEI5mm) and without known history of ischaemic heart disease, hyperlipidaemia or diabetes mellitus were studied. In all patients at baseline blood pressure and heart rate were measured, an echocardiogram, for determination of diastolic and systolic indices was performed, and fasting glucose and lipids levels were measured.
Results: Elevated glucose levels were found in 21 patients who consisted Group A and the remaining 47 patients without diabetes consisted Group B. Glucose levels were significantly higher in Group A (180mg/dl) compared to Group Β (106mg/dl); systolic dysfunction was also greater in Group A than in Group Β (EF=29.4% and EPSS=10.7mm vs. EF=34.2% and EPSS=6.8mm respectively); diastolic dysfunction was also greater in Group A than in Group Β (LAEI=0.32 vs. LAEI =0.41); cholesterol levels were higher in Group A than in Group Β (224.4mg/dl vs. 204mg/dl); and triglycerides were also higher in Group A than in Group Β (2l6.8mg/dl vs. 189mg/dl). The antihypertensive treatment was sufficient without significant differences in both groups.
Conclusions: The hyperglycemia, in our study, shows a clear significant negative effect on the systolic function of the left ventricle in the hypertensive patients. In hypertensive patients with heart failure the endothelial dysfunction and/or the insufficient treatment of diabetes may contribute to appearance of systolic dysfunction of the left ventricle. The coexistence also of diabetes and hyperlipidaemia could indicate underlying coronary arterial disease which may predispose to failure.

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Detection of myocardial ischaemia in the elderly vs the young by stress Thallium-201 scintigraphy and its relation to important coronary artery disease

Hippokratia 2001, 5 (2): 76-83

D Psirropoulos, Ap Efthimiadis, G Boudonas, I Papadopoulos, G Papadopoulos, D Ekklisiarchos, M Parthenis, T Constantinidis, N Lefkos

Abstract

The prevalence and severity of coronary atherosclerosis increase dramatically with age, that more than so mush so half of all deaths in people aged over 65 are due to coronary arterial disease (CAD) and about three fourths of all deaths from CAD occur in the elderly. The aims of our study were, firstly, to detect myocardial ischaemia development in elderly versus younger people undergoing treatment for known CAD through the use of both conventional treadmill testing and Tl201 scintigraphy, and secondly, to determine the relationship between the above non-invasive tests and angiographically confirmed important coronary artery disease (iCAD). A database from six hundred and six patients (Total=606, M=355, F=251) who had undergone coronary angiography, exercise ECG testing (ETT) using the treadmill Bruce protocol, and Tl201 scintigraphy was reviewed retrospectively. All patients had displayed clinical expressions of CAD with or without the existence of an old myocardial infarction (MI). The patients were from both sexes (M=440, F=252) and divided into two groups, according to age.Group A was composed of 265 patients aged over 65 (M=170, F=95, mean age=70.3± 5.3 years). Group Β was composed of 341 patients aged under 65 (M=185, F=156, mean age 54.4±9.1 years). Patients with uncontrolled arterial hypertension, hypertrophic cardiomyopathy, severe valve diseases, severe chronic obstructive lung diseases, severe anemia, peripheral atherosclerosis, orthopedic problems, and Parkinson's disease were excluded from the study.The term "important coronary artery disease" (iCAD) covers the following patterns of coronary anatomy: a) left main stem stenosis > 50% with or without disease elsewhere, b) proximal three vessel disease, c) three vessel disease including the proximal LAD, d) proximal two vessel disease including LAD and e) two vessel disease including the proximal LAD.Biostatistical characteristics such as sensitivity, specificity, predictive values of ETT-Tl201 were estimated.Analyzing our results we concluded that: The biostatistical parameters in predicting important CAD in elderly and younger patients by means of exercise test and thallium scintigraphy need to be redefined through more closely scheduled and prospective studies.In elderly coronary patients the appearance of positive results in both parameters of ETT-Tl201 indicates a significant possibility of iCAD existence.In coronary patients younger than 65 years the appearance of negative results in both parameters of ETT-Tl201 almost excludes iCAD in contrast to elderly patients, who display a significant proportion of iCAD.In elderly coronary patients the appearance of equivocal results in both tests indicates a significant possibility of the existence of iCAD in contrast to younger patients.

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Children's perception and approach to adoption

Hippokratia 2001, 5 (2): 84-90

E Laloumi-Vidali, A Vidalis, M Evangelakis

Abstract

The present study was conducted in order to identify the perception, of pre-school and school children of adoption, due to increasing coverage by the Mass Media of adoption issues in general, and illegal adoption in particular. A modified version of the "Primary Student Survey of Handicapped Persons Questionnaire" was administered to three non-adoptive groups of children aged 4, 7 and 9 respectively.Results revealed no impact from Mass Media on the 4-year-old group.In the 7-year-old group, especially in females, there was a more negative perception with a statistical significance (p<0.05), which indicates that 7 years old girls are receptive to Mass Media influences, and appear more vulnerable than males in dealing with the concept of adoption.On the other hand, the 9 years old group felt emotionally more secure and less influenced on Mass Media (p<0.05).An environment of inspiring confidence in, comprehension and reassurance especially on the part of teachers seems to be essential during the formative year (7 years old) in facilitating a positive adjustment to the concept of adoption and its complicated processes.

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