Renal transplantationComplication: Other problemInadequate Blood Pressure Control in Most Kidney Transplant Recipients and Patients With Coronary Artery Disease With and Without Complications
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
References (22)
- et al.
INTERHEART Study Investigators: Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study
Lancet
(2004) - et al.
Pulse pressure and risk of total mortality and cardiovascular events in patients on chronic hemodialysis
Kidney Int
(2002) - et al.
Hypertension after kidney transplantation
Am J Kidney Dis
(2004) - et al.
Improved long-term outcomes after renal transplantation associated with blood pressure control
Am J Transplant
(2005) - et al.
Cyclosporine-induced hypertension after transplantation
Mayo Clin Proc
(1994) - et al.
Does the relation of blood pressure to coronary heart disease risk change with aging?: the Framingham Heart Study
Circulation
(2001) - et al.
Relationship of blood pressure to 25-year mortality due to coronary heart disease, cardiovasular diseases, and all causes in young adult men: the Chicago Heart Association detection project in industry
Arch Intern Med
(2001) - et al.
Task Force for the Management of Arterial Hypertension of the European Society of Hypertension and of the European Society of Cardiology: European Society of Hypertension–European Society of Cardiology: 2007 Guidelines for the Management of Arterial Hypertension
J Hypertens
(2007) - et al.
Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood PressureNational Heart, Lung, and Blood Institute, National High Blood Pressure Education Program Coordinating Committee: The Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation and Treatment of High Blood Pressure
JAMA
(2003) - et al.
Systolic blood pressure, diastolic blood pressure, and pulse pressure: an evaluation of their joint effect on mortality
Ann Intern Med
(2003)
Effects of normal, pre-hypertensive, and hypertensive blood pressure levels on progression of coronary atherosclerosis
J Am Coll Cardiol
Cited by (19)
Blood pressure control according to clinical practice guidelines is associated with decreased mortality and cardiovascular events among liver transplant recipients
2020, American Journal of TransplantationBlood pressure control according to the prevalence of diabetes in renal transplant recipients
2013, Transplantation ProceedingsCitation Excerpt :The choice of a drugs depends not only on their efficacy and tolerance but also their possible impact on the renal graft and their pharmacological interference with the immunosuppressive therapy.6 CCB, particular dihydropyridine, are the most frequently prescribed hypotensive class of medications for patients after renal transplantation, namely 80% of subjects studied by Małyszko et al.17 Another classes of hypotensive regimens useful in patients after transplantation are ACEI and ARB. Assessing BP control after heart compared with kidney transplantation Przybylowski et al26 and ACEI were prescribed for 40%.
Pharmacology of Immunosuppressive Medications in Solid Organ Transplantation
2011, Critical Care Nursing Clinics of North AmericaCitation Excerpt :More recent studies, however, failed to demonstrate any benefit of the calcium channel blockers over other antihypertensive agents, namely angiotensin-converting enzyme inhibitors.12 Generally, 2 to 3 antihypertensives are necessary to adequately control blood pressure in transplant recipients.13 Similarly, hyperlipidemia occurs in 60% to 70% of patients receiving cyclosporine.14
Hypertension in Special Populations: Chronic Kidney Disease, Organ Transplant Recipients, Pregnancy, Autonomic Dysfunction, Racial and Ethnic Populations
2010, Cardiology ClinicsCitation Excerpt :In some cases, transplant renal artery stenosis may be another contributing factor to hypertension. Appropriate BP control in patients with cardiac transplantation is necessary to decrease cardiovascular complications and deterioration of graft function in patients with renal transplantation.27 Large-scale, randomized, controlled trials confirming the renal and cardiovascular benefit of BP control in patients posttransplantation are, however, not available.
Prevalence and Hypertension Treatment Schedule in Hemodialysis Patients and Renal Transplant Recipients in 2006 and 2014/2016
2018, Transplantation ProceedingsCitation Excerpt :Additionally, in spite of the ototoxicity associated with high doses of loop diuretics, their use is not recommended, especially in high doses [20,21]. These results in RTRs differ from reports provided by other centers in which CCB are the most often applied medication, namely in 80% of Polish subjects studied by Malyszko et al [11] and in 62.9% of Austrian RTRs studied by Tylicki et al [12]. The dominant role of CCB, often treated as first line hypotensive drugs in RTRs, is due to their demonstrated antihypertensive efficacy and their potential ability to counteract the vasoconstrictive effects of calcineurin inhibitors [22].
Cardiovascular and Renal Outcomes of Renin-Angiotensin System Blockade in Renal Transplant Recipients
2018, Transplantation ProceedingsCitation Excerpt :Although the use of ACEI and ARB increased in the last decades in RTRs, their use is not as widespread as in patients suffering from proteinuric nephropathies of native kidneys. ACEI or ARB are prescribed for approximately 40% of RTRs in our department (unpublished data), as a result similar to that reported by others [16,17]. It might be noted that many RTRs are patients with stage 3b or 4 CKD that are particularly prone to deterioration of graft function, hyperkalemia, and the development of anemia after treatment with ACEI or ARB.