Hypertension after renal transplantation
- John Vella, MD, FACP, FRCP, FASN
John Vella, MD, FACP, FRCP, FASN
- Associate Professor of Medicine
- Tufts University School of Medicine
- Daniel C Brennan, MD, FACP
Daniel C Brennan, MD, FACP
- Editor-in-Chief — Nephrology
- Section Editor — Renal Transplantation
- Professor of Medicine
- Washington University School of Medicine
- Section Editors
- Barbara Murphy, MB, BAO, BCh, FRCPI
Barbara Murphy, MB, BAO, BCh, FRCPI
- Section Editor — Renal Transplantation
- Professor of Medicine
- Mount Sinai School of Medicine
- George L Bakris, MD
George L Bakris, MD
- Editor-in-Chief — Nephrology
- Section Editor — Hypertension
- Professor of Medicine
- The University of Chicago
Hypertension is prevalent in most patients with ESRD/advanced CKD. The blood pressure frequently often rises early after kidney transplantation after saline loading interacts with initial high-dose immunosuppression. Long-term blood pressure is often easier to control after transplantation, as long as the individual achieves a good GFR. However, poorly controlled blood pressure is common among kidney transplant recipients [1-4]. In a single-center study, for example, only 5 percent of kidney transplant patients were normotensive, as defined by blood pressures less than 130/80 mmHg, as measured by ambulatory blood pressure monitoring .
Elevated blood pressure and pulse pressure can result in decreased allograft survival and left ventricular hypertrophy, with the latter being an independent risk factor for heart failure and death in the general population and renal transplant recipients [5-9]. (See "Clinical implications and treatment of left ventricular hypertrophy in hypertension".)
RISK FACTORS AND PATHOGENESIS
The following risk factors have been associated with a higher incidence of posttransplant hypertension [6,10-14]:
●Delayed and/or chronic allograft dysfunction
●Deceased-donor allografts, especially from a donor with a family history of hypertension
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- RISK FACTORS AND PATHOGENESIS
- Role of glucocorticoids
- Role of calcineurin inhibitors
- RENAL ARTERY STENOSIS
- - Arteriography
- - Ultrasonography
- - Magnetic resonance imaging
- - Spiral computed tomography angiography
- - Radioisotope renography
- - Angioplasty
- - Surgery
- DEFINITIONS AND GOALS OF THERAPY
- Patient is taking a calcineurin inhibitor
- - Calcium channel blockers
- - Angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and other agents
- Patient is not taking a calcineurin inhibitor
- Resistant hypertension
- SUMMARY AND RECOMMENDATIONS