Treatment of Hypertension in Renal Transplant Recipients in Four Independent Cross-Sectional Analyses

Abstract

Background/Aims: This retrospective study analysed hypertension management and adherence to blood pressure (BP) targets among renal transplant recipients (RTRs) under specialized care in the Outpatient Transplantation Unit in the Department of Nephrology, Transplantology and Internal Medicine at Gdansk University Hospital. Methods: Medical records of 101, 316, 639 and 818 RTRs diagnosed with hypertension, who received outpatient care in 2001, 2006, 2011 and 2014, respectively were analysed in four independent cross-sectional surveys. All RTRs received antihypertensive regimens. Results: The overall most commonly used antihypertensive agents were beta-blockers (BB) (range 66.3-82.5%) followed by calcium channel blockers (CCB) (range 52.8-64.2%). Whilst a significant, upward tendency of BB usage (p<0.01) was observed, CCB usage (p<0.001) displayed a downward tendency as a first line therapy in the subsequent years. The average number of antihypertensive agents used per patient increased significantly from 2.24±1.03 in 2001 to 2.55±1.25 in 2014 (p<0.05). The most frequently used combination of hypotensive therapy consisted of two or three antihypertensive drugs depending on the survey. The most common two drug combination consisted of BB and CCB followed by BB accompanied by angiotensin converting enzyme inhibitors. A significant, upward tendency in the use of four (p<0.001) and five (p<0.05) antihypertensive drugs simultaneously, was observed in subsequent years. The target values of BP i.e. <140/90 mmHg were accomplished in 47, 58, 60 and 46% of RTRs in subsequent years. In a secondary - stratified analysis of data from 2014, younger patients (p<0.05), patients with better graft function (p<0.001), patients treated with a higher number of antihypertensive agents (p<0.001) and those not treated with BB (p<0.01) were shown to reach the BP target of below 140/90 mmHg more often. Conclusion: The study showed intensification of hypertension treatment in RTRs in subsequent years with BB assuming a dominant role.

Antihypertensive Treatment in Kidney Transplant Recipients—A Current Single Center Experience

“…In the present study, we analyzed data from our transplant center and divided patients into four groups based on the number of different antihypertensive drugs. The distribution of main antihypertensives used in our cohort was comparable to that of other transplant studies [13]. Our data showed that the number of different antihypertensives of KTx recipients is a strong predictor of poor allograft function and survival.…”

“…However, multivariable Cox regression could not confirm beta-blockers as a risk factor for reduced death-censored allograft survival. Although they are the most frequently used antihypertensive agents after KTx in our cohort as well as in others [13,33], data on their influence on the outcomes of renal allograft outcome is scarce. Their frequent usage might be related to a high percentage of patients with chronic heart failure and/or arrhythmias as atrial fibrillation in the KTx patient collective [18,19].…”

“…A recent cross-sectional study from Poland showed that beta-blockers were the most commonly used antihypertensive agents, followed by Calcium channel blockers (CCB), angiotensin-converting enzyme inhibitors (ACE-I)/Angiotensin-II-receptor-blockers (ARB), and diuretics [13]. The remaining drug classes, such as alpha1-receptor-antagonists, anti-sympathotonics and vasodilators are usually prescribed as reserve antihypertensives.…”

Approach and Management of Hypertension After Kidney Transplantation

“…In this review, we focus on antihypertensive medications and briefly review bilateral native nephrectomy and RDN of native kidneys. (135). Beta-blockers were the most common antihypertensive medication used in this cohort followed by calcium channel blockers.…”

“…The cardioprotective effects and survival benefit of beta-blockers make them a favored medication in the general (161) and ESRD populations (162)(163)(164)(165). In kidney transplant recipients, a recent retrospective study from 2001 to 2014 showed that betablockers are the most common used antihypertensive medication (135). In addition, Aftab et al (166) conducted a single center retrospective study in 321 kidney transplant recipients over a 10 ± 4 year follow-up period and found that those who took beta-blockers had a significant survival advantage compared to those who did not.…”