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Journal of Hypertension:
Original papers: Endothelium

Blood pressure, endothelial function and circulating endothelin concentrations in liver transplant recipients

Cífková, Renataa; Pit'ha, Jana; Trunecuka, Pavelb; Lánská, Vera; Jindra, Antonínd; Plásuková, Markétaa; Peterková, Ludmilaa; Hrncuárková, Halimab; Horký, Kareld

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Abstract

Objectives: To study candidates for liver transplant before and 6 weeks after transplant, and to elucidate the role of endothelial dysfunction and plasma endothelin concentrations in the development of hypertension.

Design: Prospective follow-up study.

Setting: Institutional, outpatient.

Patients and controls: Fifteen patients (11 men, four women, mean age 46.7 ± 13.2 years) with end-stage liver disease (ESLD) and healthy volunteers of comparable age and sex.

Methods: We performed office blood pressure readings and 24 h ambulatory blood pressure monitoring (ABPM), measurements of endothelial-dependent vasodilatation using high-resolution ultrasound in the brachial artery at rest and during reactive hyperemia, and plasma endothelin-1 assays 3 months before and 6 weeks after the transplant.

Results: Office systolic and diastolic blood pressures increased significantly 6 weeks after liver transplantation (from 116.6 ± 14.1 to 139.9 ± 19.5 mmHg and from 68.6 ± 9.5 to 84.1 ± 9.8 mmHg, respectively; both P < 0.001). Hypertension based on office blood pressure readings increased from 6.7 to 40% (P < 0.05). Mean 24 h systolic blood pressure increased from 118.7 ± 10.3 to 140.0 ± 19.0 mmHg (P < 0.001), mean 24 h diastolic blood pressure increased from 86.0 ± 7.7 to 104.8 ± 13.9 mmHg (P < 0.001) and heart rate increased from 74.8 ± 10.2 to 80.2 ± 8.2 beats/min (P < 0.05). Brachial artery flow-mediated dilatation did not change throughout the study (before transplant: 4.2 ± 4.0%; after transplant: 6.3 ± 5.4%; NS) and did not differ from that in controls (5.2 ± 3.8%). Plasma endothelin-1 was increased in patients with ESLD (15.3 ± 2.6 pg/ml) compared with controls (5.6 ± 0.4 pg/ml; P < 0.001) and remained unchanged 6 weeks after liver transplantation (14.1 ± 3.7 pg/ml).

Conclusion: Our results show increased blood pressure with suppressed circadian blood pressure variability in liver graft recipients 6 weeks after transplant and no change in endothelial function and plasma endothelin concentrations. Therefore, the blood pressure increase documented in our study cannot be explained by endothelial dysfunction. Twenty-four hour ABPM should be performed routinely in patients who have undergone liver transplant.

© 2001 Lippincott Williams & Wilkins, Inc.

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