Page 29 - Heart Transplant Protocol

Heart Function Service: Heart Transplant Protocols

Hypertension Protocol

AAP Guidelines, 2004 Systolic or Diastolic Percentiles
th
Normal <90 percentile
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Prehypertension 90 to <95 percentile if BP exceeds 120/80
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even if <90 percentile up to <95
percentile
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Stage 1 Hypertension 95 -99 percentile + 5 mmHg
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Stage 2 Hypertension >99 percentile + 5 mmHg

Hypertension is common in the immediate post-transplant period as the circulation has not adjusted to
the higher cardiac output. It should be managed to prevent seizures or the development of Posterior
reversible encephalopathy syndrome (PRES). Hypertension usually resolves over weeks or months but
may return years later due to renal insufficiency. Hypertension may also be due to side effects from
immunosuppression so it is not uncommon for our patients to require long term anti-hypertensives.

Immediate Post-Transplant Management

 Evaluate and treat secondary causes of hypertension (ie. Pain, renal, neuro, endocrine)
 Consider role of antihypertensive therapy
o Immediate Post-operative
 Milrinone infusion
 Nitroprusside (Nipride) infusion
 Amlodipine (long acting dihydropyridine calcium channel blocker)
 Can be given daily or consider BID if suboptimal control
 Prefer due to no renal side effects
o If hypertension is uncontrolled with above therapy
 Clonidine
 Hydralazine
 Bidil (Isosorbide Dinitrate and Hydralazine Hcl)

By the time off discharge most children needing maintenance BP control will have transitioned to an
ACE inhibitor (ie. Enalapril, Lisinopril) which is preferred due to ability to reverse fibrotic changes, cause
less proteinuria, and help protect the kidney from calcineurin inhibitor’s side effects

Standard education regarding blood pressure control

 Low salt diet, healthy diet, regular exercise and weight control

Updated November 9, 2017 29