Transplantation |

Orthostatic Hypotension Appears to be Common Among Lung Transplant Recipients FREE TO VIEW

Macé Schuurmans, MD; Johannes Wild; Aju Pazhenkottil, MD; Ilhan Inci, MD; Malcolm Kohler, MD; Christian Benden, MD
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Zurich University Hospital, Pulmonology, Zurich, Switzerland

Chest. 2014;145(3_MeetingAbstracts):633A. doi:10.1378/chest.1836513
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SESSION TITLE: Transplantation Posters

SESSION TYPE: Poster Presentations

PRESENTED ON: Saturday, March 22, 2014 at 01:15 PM - 02:15 PM

PURPOSE: Hypertension is frequent among lung transplant recipients (LTRs) and is generally considered the consequence of long-term calcineurin inhibitor use. Therefore LTRs frequently require antihypertensive medication. Blood pressure (BP) measurements guiding medication optimization in our setting are performed exclusively in a sitting position. In the past we have noted a number of falls (with hip fractures) and some LTRs reporting dizziness after standing up. Too strict blood pressure control may have contributed to this. A possible alternative explanation may be undiagnosed orthostatic hypotension (OH). The aim of this study was to determine the frequency of OH among a pilot sample of consecutive stable LTRs with and without antihypertensive medication.

METHODS: Serial automated BP and pulse measurements in supine and standing positions were performed according to a standardized protocol in stable outpatients and inpatients prior to discharge from the clinic. Baseline characteristics including medication as well as symptoms during the test were recorded. Descriptive statistics were performed. A pathologic orthostasis test was defined as decrease of systolic BP by at least 20 mmHg or in diastolic BP by at least 10 mmHg within 3 minutes of standing.

RESULTS: Consecutive LTRs in a stable condition were assessed (15 outpatients and 15 inpatients) by serial BP measurements in supine and then upright standing positions. 18 women were included. Mean age was 45 years and mean duration since lung transplantation was 1602 days. Of the 30 LTRs investigated 8 were diabetic, 21 were receiving antihypertensive medication with a mean number of antihypertensive drugs of 1.4 and 10 were additionally receiving diuretics. Nine LTRs had OH and 3 additionally had supine hypertension. Of the 9 LTRs with OH, 7 had a systolic BP decrease, one a diastolic BP decrease and one LTR had both. Three of the 9 LTRs were symptomatic during the test. Further analysis will include a differentiated evaluation of risk factors for neurogenic, hypovolaemic, and drug induced OH.

CONCLUSIONS: Thirty percent of LTRs in this pilot study had orthostatic hypotension. Ten percent also had supine hypertension. These patients require improved blood pressure control as well as instructions on how to deal with it in daily life. Confirmation of this observation in a larger study and elucidation of the etiology is needed.

CLINICAL IMPLICATIONS: Awareness of possible orthostatic hypotension in LTRs may contribute to a better BP management and thus prevent falls.

DISCLOSURE: The following authors have nothing to disclose: Macé Schuurmans, Johannes Wild, Aju Pazhenkottil, Ilhan Inci, Malcolm Kohler, Christian Benden

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