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Hypertension after renal transplantation

Daniel C Brennan, MD, FACP
Section Editors
Barbara Murphy, MB, BAO, BCh, FRCPI
George L Bakris, MD
Deputy Editor
Albert Q Lam, MD


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 [2].

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".)


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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Literature review current through: Nov 2017. | This topic last updated: Nov 02, 2016.
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