[The cardiologist and immunosuppressive therapy].

The monitoring of immunosuppressive therapy may involve the cardiologist in various settings. TNF inhibitors are contra-indicated in patients with NYHA III-IV cardiac failure. This contra-indication is not absolute for etanercept. In patients with milder forms of cardiac failure, TNF inhibitors can be prescribed in the absence of alternative therapy. A cardiac follow-up is necessary in this situation. Cyclosporine and tacrolimus are both nephrotoxic and hypertensive drugs. For the treatment of arterial hypertension induced by the immunosuppressive therapy, first-line recommended drugs are calcium-blockers and renin-angiotensin inhibitors. Other antihypertensive classes may also be used in these patients. Calcium-blockers may cause frequent oedema and plasma calcineurin-inhibitor concentration elevations. Moreover, cyclosporine+calcium-blocker association may induce gingival hypertrophy and gynecomastia.