Background Arterial hypertension is common after renal transplantation (Tx) and is present in about 70–90% kidney transplant recipients. It is one of major nonimmunologic risk factors that directly relate to patient and graft survivals. There are variety of causes that lead to hypertension after renal Tx: dependent on transplanted kidney, on native kidneys and related to immunosuppressive therapy. The choice of hypotensive drug depends not only on its possible impact on renal graft but also on the pharmacological interference with immunosuppressive medicines. The aim of the study was to assess blood pressure control in kidney transplant recipients.
Material and methods The retrospective analysis of 190 (mean age 50 y) patients — 54% male and 46% female was made based on the medical documentation. The medical history, BP measurements twice a visit during three visits, laboratory tests (including cyclosporine level) were taken. The kind of hypotensive and immunosuppressive drugs and the connection between the number and kind of them and BP control was analyzed.
Results Hypertension was present in 78% patients (n = 149). Mean blood pressure (BP) was 129.76 ± 12.76/79.3 ± 8.7 mm Hg. The study cohort was divided according to BP: group I (62 persons — 33%) with mean BP ≥ 140/ /90 mm Hg, group II (128 persons) — with BP < 140/ /90 mm Hg. The time after Tx was 33.6 months in group I and 75.4 months in group II (p < 0.05). The median GFR, according to MDRD formula in group I comparing to group II was 67.7 v. 57.6 ml/min/1.72 m², respectively (p < 0.05). The cyclosporine level was significantly higher in the group with uncontrolled hypertension (132 v. 114.2 ng/ml; p = 0.0029). The most commonly used hypotensive drugs were β-blocker (38.5%, n = 64), then Cablocker (28.7%, n = 48) and ACEI (24.5%, n = 41). Patients with uncontrolled BP used diuretics more often (9%, n = 4 v. 0.9%, n = 1, respectively; p = 0.011). The median number of antihypertensive agents used by one patient was 1; 55 patients (29%) were treated with no hypotensive drug and 1 patient used 4 drugs. BP was significantly higher in the males comparing to females (133.45 ± 10.57/81.21 ± 7.19 v. 125.46 ± 14.25/76.98 ± 9.8 mm Hg, respectively) (p < 0.05). There was adverse correlation between GFR and time after renal Tx (–0.2639, p = 0.0001).
Conclusions Hypertension is a common finding in kidney transplant recipient. More than 1/3 of study population, especially those with shorter time after Tx, had abnormal BP based on office BP measurement. ABPM should be used to detect masked and hidden uncontrolled hypertension in this population. Too less hypotensive drug was used, particularly RAS blockers. More aggressive antihypertensive treatment using combined drugs, including RAS blocker, would provide adequate BP control in study cohort including kidney transplant recipients with high cardiovascular risk.
Arterial Hypertension 2011, vol. 15, no 5, pages 283–289