Elsevier

Transplantation Proceedings

Volume 41, Issue 8, October 2009, Pages 3069-3072
Transplantation Proceedings

Renal transplantation
Complication: Other problem
Inadequate Blood Pressure Control in Most Kidney Transplant Recipients and Patients With Coronary Artery Disease With and Without Complications

https://doi.org/10.1016/j.transproceed.2009.07.078Get rights and content

Abstract

Background

Hypertension is a widely accepted risk factor for coronary artery disease (CAD), chronic heart failure, and chronic kidney disease (CKD). In kidney transplant recipients, the prevalence of hypertension is 60% to 80%.

Objective

To assess the prevalence of target blood pressure in 2 high-risk populations: patients with CAD and kidney allograft recipients.

Patients and Methods

The study included 520 patients with CAD and 150 kidney allograft recipients. In the CAD population, 30% of patients had diabetes mellitus and 33% had CKD. In kidney allograft recipients, 52% had diabetes (15%) or CKD. Hypertension was diagnosed and treated in 72% of patients with CAD and 90% of kidney allograft recipients. In the CAD population without diabetes but with CKD, target blood pressure was achieved in 47% compared with 31% in the CKD population. Treatment included angiotensin-converting enzyme (ACE) inhibitors in 72% of patients, calcium channel blockers in 28%, diuretic agents in 27%, and β-blockers in 89%. In allograft recipients, more than 60% required 3 or more hypotension agents. Only 40% demonstrated target blood pressure. In the latter group, the most commonly used hypotension agents were ACE inhibitors in 38%, calcium channel blockers in 84%, diuretic agents in 51%, β-blockers in 68%, and α-blockers in 15%.

Conclusion

Both cohorts demonstrated a high prevalence of hypertension. Despite polytherapy, optimal blood pressure control was not achieved in most patients. Greater efforts should be expended to optimize blood pressure control, in particular in the presence of comorbidities. In transplant recipients, β-blockers are widely used, whereas ACE inhibitors are used infrequently.

Section snippets

Patients and Methods

The present study included 529 patients (340 men and 172 women). In patients undergoing percutaneous coronary interventions in our Department of Invasive Cardiology because of ischemic heart disease, the prevalence of male patients vs female patients was significant (66.4% vs 33.6%; P < .001). The 150 kidney allograft recipients in our outpatient unit included 74 men and 66 women. Clinical data were obtained from hospital or ambulatory records. At admission and regular follow-up visits, we

Results

Basal clinical and biochemical characteristics are given in Table 1. In the CAD population, 30% of patients had diabetes and 33% had CKD. In kidney allograft recipients, 52% had diabetes (15%) or CKD. Hypertension was diagnosed and treated in 72% of patients with CAD and 90% of allograft recipients. In the CAD population without diabetes or CKD, only 47% achieved the target blood pressure compared with only 31% of patients with diabetes or CKD. Treatment included angiotensin-converting enzyme

Discussion

The present study included 2 high-risk populations: patients with CAD and kidney allograft recipients. In the transplant recipients, the prevalence of HTN was as high as 90%. In the CAD population, almost one-third of patients had diabetes or CKD, compared with more than half of the transplant recipient population. The target blood pressure in these patients was less than 130/80 mm Hg; however, only 31% achieved this goal. In contrast, in the CAD population without diabetes or CKD, the target

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