Hypertension in the Transplanted Patient

Abstract

Hypertension is a common finding after renal transplantation, and it has a variety of underlying mechanisms. One reason is the type of immunosuppressive therapy, with a higher prevalence of hypertension in cyclosporine-treated patients. Cyclosporine interferes with several humoral and neural systems which are involved in blood pressure regulation such as the renin-angiotensin system, endothelins, nitric oxide, prostaglandins and the sympathetic nervous system. Other pathomechanisms for posttransplant hypertension are uncontrolled renin secretion of the native kidneys, polycythemia, recurrence of renal disease in the graft and renal failure. Renal transplant artery stenosis is a potentially treatable cause of post-transplant hypertension and several techniques such MRT angiography, Doppler sonography and conventional angiography are available. The diagnosis and treatment of hypertension are of high importance in general for the transplanted patient, and especially for the long-term prognosis of graft function.

Improved Long‐Term Outcomes After Renal Transplantation Associated with Blood Pressure Control

“…Currently, there are no guidelines on the optimal level of BP control in renal transplant recipients or on the most appropriate antihypertensive agents (18,19). It may be argued that because newer antihypertensive agents such as ACE inhibitors have renoprotective effects independent of BP (20,21), improved long-term outcomes may have been a result of these other renal benefits.…”

Posttransplantation care: Role of the primary care physician versus transplant center

“…32 Corticosteroids also contribute to hypertension by producing hypervolemia. 33 Because of the morbidity of cardiovascular disease, aggressive intervention is needed to maintain blood pressure at less than 140/90 mm Hg.…”

Hypertension in special populations

“…For example, posttransplant hypertension now complicates 67% to 90% of kidney transplants as compared to a 45% to 50% occurrence during the precyclosporine era [89,90]. Similar trends have been noted in recipients of bone marrow, livers, and hearts.…”

“…Thus, they will have reduced natriuretic capacity and will likely be highly sensitive to dietary sodium. In addition, the median number of antihypertensive drugs required to achieve BP control after kidney transplantation is two when serum creatinine is \1.3 mg/dL and increases to four when serum creatinine is between 1.3 and 2.0 mg/dL [90].…”