Hypertension After Renal Transplantation

Ponticelli, Claudio; Montagnino, Giuseppe; Aroldi, A.; Angelini, Claudio; Braga, Mario; Tarantino, A

doi:10.1016/0272-6386(93)70098-j

Cited by 96 publications

(49 citation statements)

References 25 publications

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“…It is also known from the literature that vasoconstrictors, such as angiotensin-II, endothelin-1 and thromboxane-A2, may stimulate to proliferation of smooth muscle cells, either directly or acting in synergy with growth factors (Figure 1). It has been claimed that pretransplant and posttransplant hypertension is a major risk factor for chronic renal transplant dysfunction [28][29][30][31][32][33] since patients with deteriorating graft function had a higher level of treatment with antihypertensive drugs. 29 Hypertension was also recently suggested to be an independent risk factor for chronic graft failure, 34 based upon a multivariate analysis of posttransplant blood pressure and long-term kidney graft outcome.…”

Section: Hypertension and Accelerated Atherosclerosismentioning

confidence: 99%

Accelerated atherosclerosis in the transplant recipient: role of hypertension

et al. 1998

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An accelerated atherosclerosis may occur in the native arteries of a transplant recipient as well as in arteries of transplanted kidneys or hearts. The dominating cause of patient mortality are cardiovascular diseases, where ischaemic heart disease is predominant. The accelerated form of arteriosclerosis which takes place in transplanted kidneys and hearts, has a complex pathogenesis, which includes both immunological and non-

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Section: Hypertension and Accelerated Atherosclerosismentioning

confidence: 99%

Accelerated atherosclerosis in the transplant recipient: role of hypertension

et al. 1998

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“…Hypertension after renal transplantation (RTx) affects more than 50% of allograft recipients [23] and even occurs in 80% of patients treated with cyclosporine A (CYA), as shown in a 5-year follow-up study [21]. Since graft survival is impaired in patients with uncontrolled hypertension [21,271, effective antihypertensive therapy is required for renal allograft recipients.…”

Section: Introductionmentioning

confidence: 99%

“…Since graft survival is impaired in patients with uncontrolled hypertension [21,271, effective antihypertensive therapy is required for renal allograft recipients.…”

Section: Introductionmentioning

confidence: 99%

Long-term follow-up of ACE-inhibitor versus beta-blocker treatment and their effects on blood pressure and kidney function in renal transplant recipients

et al. 2003

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Hypertension and nephrotoxicity are frequent complications of cyclosporine‐induced immunosuppression in renal transplant recipients. Long‐term antihypertensive treatment is obligatory for hypertensive transplant patients, to protect allograft function. The use of angiotensin‐converting enzyme (ACE) inhibitors in the anti‐hypertensive treatment of renal transplant recipients who receive immunosuppression with cyclosporine has long been discussed controversially. The aim of this prospective study, with a duration of 2 years and a follow‐up of another 3 years, was to estimate the long‐term antihypertensive potential of quinapril compared with that of the β‐blocker atenolol and to compare their effects on renal allograft function and proteinuria in 96 hypertensive renal transplant recipients who Received: cyclosporine A as immunosuppressive therapy. Patients were randomly assigned to receive either quinapril (group Q) or atenolol (group A) as anti‐hypertensive treatment. Forty patients of each group completed the 5‐year observation period according to protocol. Intention‐to‐treat and according‐to‐protocol analyses were performed. With the patients starting at similar baseline blood pressure values, both agents, atenolol and quinapril, decreased systolic and diastolic blood pressure (SBP, DBP) as well as middle arterial pressure (MAP) and pulse pressure (PP) to a similar extent (ΔSBP: group Q: −8±3 vs group A mmHg: −5±3; ΔDBP: −5±2 vs −4±2 mmHg; ΔMAP: −6±2 vs −5±2 mmHg; ΔPP: −2±2 vs −1±3 mmHg; mean ± SEM). Neither serum creatinine levels nor Cockcroft‐Gault clearance had changed significantly in either group after the 5‐year period (Δcreatinine: 0.1±0.1 vs 0.2±0.2 mg/dl; ΔCockcroft‐Gault clearance: 3.9±4.6 vs 2.8±4.3 ml/min; mean ± SEM). Urinary protein excretion remained stable among the quinapril‐treated patients, whereas a significant increase was observed in the atenolol group during the 5‐year study period (group Q: from 0.52±0.08 to 0.54±0.14 g/24 h; group A: from 0.34±0.03 to 0.72±0.13 g/24 h, P<0.02; mean ± SEM). Albuminuria increased comparably in both groups, while the excretion of α‐microglobuline increased slightly in the atenolol group, but decreased slightly in the quinapril group. The difference between the groups failed to be statistically significant (ANOVA, P<0.056). In conclusion, quinapril and atenolol may be considered suitable and safe substances in the long‐term treatment of hypertensive renal transplant recipients since both agents prove to be effective in anti‐hypertensive treatment, and keep allograft function stable over a period of 5 years.

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“…1,2 Probably because of the elevated absolute risk, it has taken fewer patients to demonstrate the benefits of lowering elevated BPs in transplant recipients than in pretransplant patients. 3 Because of this higher absolute risk, there are special considerations which arise in the treatment of hypertension in transplant recipients which are not present in patients with all native organs present. 1 When the issue of 'traditional drug therapy of hypertension in the transplant recipient' is addressed, multiple questions come to mind which must be answered before recommendations for a specific patient can be given.…”

Section: Introductionmentioning

confidence: 99%

Traditional drug therapy of hypertension in transplant recipients

1998

J Hum Hypertens

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Hypertension is a very common condition among recipients of transplanted organs, and is often related to immunosuppressive therapy. In many transplant centres, calcium antagonists are often used as first-line antihypertensive drug therapy, not only because of efficacy in lowering blood pressure, but also because certain members of the class have a 'beneficial' drugdrug interaction with cyclosporin, which decreases the cost of administering this very expensive immunosuppressant. Diuretics are often used both for blood pressKeywords: transplant recipients; cyclosporin; calcium antagonists IntroductionThe elevation of blood pressure (BP) which commonly occurs in transplant recipients increases the risk of cardiovascular complications in these patients, just as hypertension increases risk in patients who have all of their own original organs intact.1,2 Probably because of the elevated absolute risk, it has taken fewer patients to demonstrate the benefits of lowering elevated BPs in transplant recipients than in pretransplant patients.3 Because of this higher absolute risk, there are special considerations which arise in the treatment of hypertension in transplant recipients which are not present in patients with all native organs present. 1When the issue of 'traditional drug therapy of hypertension in the transplant recipient' is addressed, multiple questions come to mind which must be answered before recommendations for a specific patient can be given. Several of these questions include: (1) 'Which are the "traditional drugs" that should be considered?' (2) 'Which organ was transplanted?' which in the USA is a way of asking also, 'Which physicians are caring for the patient?' (3) 'Which of the common sequelae of hypertension are we attempting to prevent with our treatment?' The answers to these questions must be sought before individualising therapy, because patients with different transplanted organs should be protected from the ravages of high BP, which manifests in different ways.

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Hypertension After Renal Transplantation

Cited by 96 publications

References 25 publications

Accelerated atherosclerosis in the transplant recipient: role of hypertension

Accelerated atherosclerosis in the transplant recipient: role of hypertension

Long-term follow-up of ACE-inhibitor versus beta-blocker treatment and their effects on blood pressure and kidney function in renal transplant recipients

Traditional drug therapy of hypertension in transplant recipients

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