Hypertension and Transplantation Medicine

Hypertension after renal transplantation is a strong predictor of patient and graft survival. In transplant recipients, hypertension is usually defined as blood pressure >140/90 mmHg or likewise if a patient is treated with antihypertensive drugs. Cardiovascular morbidity and mortality and shortened allograft survival are important consequences of inadequate control of hypertension. Hypertension in renal transplant recipients is common and ranges from 50% to 80% in adult recipients and from 47% to 82% in pediatric recipients.

Donor and recipient factors, acute and chronic allograft injury, and immunosuppressive medications may each explain some of the pathophysiology of post-transplant hypertension. As observed in other patient cohorts, renal artery stenosis and adrenal causes of hypertension may be important contributing factors. Notably, BP treatment goals for renal transplant recipients remain an enigma because there are no adequate randomized controlled trials to support a benefit from targeting lower BP levels on graft and patient survival. The potential for drug-drug interactions and altered pharmacokinetics and pharmacodynamics of the different antihypertensive medications need to be carefully considered.

To date, no specific antihypertensive medications have been shown to be more effective than others at improving either patient or graft survival. Identifying the underlying pathophysiology and subsequent individualization of treatment goals are important for improving long-term patient and graft outcomes in these patients.

 

  • Solid organ transplantation
  • Arterial hypertension
  • Organ transplant monitoring
  • Drug-drug interactions
  • Transplant coordinator

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