Hypertension prophylaxis with omega-3 fatty acids in heart transplant recipients

Department of Cardiology, National Hospital, Oslo, Norway.

OBJECTIVES: This study sought to determine whether omega-3 fatty acids act as hypertension prophylaxis in heart transplant recipients and have an impact on vascular reactivity. BACKGROUND: Cyclosporine-induced hypertension is probably related to endothelial dysfunction. Suggested vasodilatory mechanisms of omega-3 fatty acids may therefore be particularly beneficial in heart transplant recipients. METHODS: Heart transplant recipients were randomized to receive either 4 g of omega-3 fatty acids (treatment group, n = 14) daily or corn oil (placebo group, n = 14) from the fourth postoperative day. Twenty-four hour blood pressure monitoring was performed at day 12 and 1,2,3 and 6 months postoperatively. Microvascular endothelium-dependent vasodilation, evaluated by skin laser Doppler perfusion measurements of postocclusive reactive hyperemia, was determined preoperatively and at the end of the study. RESULTS: With comparable characteristics at the time of randomization, blood levels of cyclosporine did not at any point differ between the groups. After 6 months, systolic blood pressure decreased 2 +/- 4 mm Hg (mean +/- SEM) in the treatment group and increased 17 +/- 4 mm Hg in the placebo group (p < 0.01), whereas diastolic blood pressure increased 10 +/- 3 and 21 +/- 2 mm Hg (p < 0.01), respectively. The decrease in systolic blood pressure was inversely proportional to increases in concentrations of serum eicosapentaenoic and docosahexaenoic acid (p = 0.01). After 6 months, five patients in the treatment group and nine in the placebo group needed additional antihypertensive treatment. Although the endothelial-dependent phase of the reactive hyperemic response remained unchanged in the treatment group, it decreased significantly in the placebo group. CONCLUSIONS: Postoperative daily administration of 4 g of omega-3 fatty acids in heart transplant recipients is effective as hypertension prophylaxis, depending on increases in serum eicosapentaenoic and docosahexaenoic acids. Preservation of microvascular endothelial function, demonstrated by a more pronounced response to forearm skin ischemia in the treatment group, may contribute to the hypotensive role of omega-3 fatty acids.

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