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Erschienen in:

07.08.2023 | original Article

Blood pressure management and long-term outcomes in kidney transplantation: a holistic view over a 35-year period

verfasst von: Lionel Tchatat Wangueu, Jean-Baptiste de Fréminville, Philippe Gatault, Matthias Buchler, Hélène Longuet, Theodora Bejan-Angoulvant, Benedicte Sautenet, Jean-Michel Halimi

Erschienen in: Journal of Nephrology | Ausgabe 7/2023

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Abstract

Introduction

Hypertension is a burden for most kidney transplant recipients. Whether respect of hypertension guidelines results in better outcomes is unknown.

Methods

In this multicenter study, office blood pressure at 12 months following transplantation (i.e., after > 20 outpatient visits), and survival were assessed over 35 years among 2004 consecutive kidney transplant recipients who received a first kidney graft from 1985 to 2019 (follow-up: 26,232 patient-years).

Results

Antihypertensive medications were used in 1763/2004 (88.0%) patients. Renin-angiotensin-system blockers were used in 35.6% (47.1% when proteinuria was > 0.5 g/day) and calcium-channel blockers were used in 6.0% of patients. Combined treatment including renin-angiotensin-system-blockers, calcium-channel blockers and diuretics was used in 15.4% of patients receiving ≥ 3 antihypertensive drugs.

Blood pressure was controlled in 8.3%, 18.8% and 43.1%, respectively, depending on definition (BP < 120/80, < 130/80, < 140/90 mmHg, respectively) and has not improved since the year 2001. Two-thirds of patients with uncontrolled blood pressure received < 3 antihypertensive classes. Low sodium intake < 2 g/day (vs ≥ 2) was not associated with better blood pressure control.

Uncontrolled blood pressure was associated with lower patient survival (in multivariable analyses) and graft survival (in univariate analyses) vs controlled hypertension or normotension. Low sodium intake and major antihypertensive classes had no influence on patient and graft survival.

Conclusions

Pharmacological recommendations and sodium intake reduction are poorly respected, but even when respected, do not result in better blood pressure control, or patient or graft survival. Uncontrolled blood pressure, not the use of specific antihypertensive classes, is associated with reduced patient, and to a lesser extent, reduced graft survival, even using the 120/80 mmHg cut-off.

Graphical abstract

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Titel: Blood pressure management and long-term outcomes in kidney transplantation: a holistic view over a 35-year period
verfasst von: Lionel Tchatat Wangueu
Jean-Baptiste de Fréminville
Philippe Gatault
Matthias Buchler
Hélène Longuet
Theodora Bejan-Angoulvant
Benedicte Sautenet
Jean-Michel Halimi
Publikationsdatum: 07.08.2023
Verlag: Springer International Publishing
Erschienen in: Journal of Nephrology / Ausgabe 7/2023
Print ISSN: 1121-8428
Elektronische ISSN: 1724-6059
DOI: https://doi.org/10.1007/s40620-023-01706-9

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Blood pressure management and long-term outcomes in kidney transplantation: a holistic view over a 35-year period