title: Hypertension and long-term renal allograft survival: effect of early glomerular filtration rate.
abstract: BACKGROUND
  For many years, hypertension has been related to long-term survival of patients and kidney grafts, although the nature of this relationship has not been completely defined. The aim of this study was to analyse the influence of early glomerular filtration rate on post-transplant hypertension and on graft survival.
  
  
  METHODS
  A total of 432 kidney transplanted patients on cyclosporin therapy, with a functioning graft for at least 1 year, were studied. They were divided into two groups depending on their early creatinine clearance: group A [<60 ml/min (n=270)] and group B [>60 ml/min (n=162)].
  
  
  RESULTS
  There were no differences in sex, aetiology of renal failure, number of retransplants, PRA, HLA mismatches and pre-transplant blood pressure. One year after transplantation, blood pressure was higher in group A (systolic BP 148/diastolic BP 86/mean BP 117) than in group B (systolic BP 140/diastolic BP 82/mean BP 111) (P<0.003). We observed a negative correlation between early creatinine clearance and 1-year blood pressure (P<0.01). Five and 10 year graft survival was 60 and 37% in group A and 87 and 69% in group B, respectively (P<0.000). A multivariate Cox analysis showed that 1-year blood pressure (P<0.0029, RR=1.76) and early creatinine clearance (P<0.000, RR=3.27) had a significant influence on graft survival.
  
  
  CONCLUSIONS
  The 1-year post-transplant blood pressure is a non-immunological risk factor in long-term graft survival. Patients with a lower initial glomerular filtration rate are more susceptible to the development of secondary hypertension and worse graft survival.
authors.affiliation: Nephrology Service, University Hospital Marques de Valdecilla, 39008 Santander, Spain.
authors.forename: G
authors.initials: G
authors.lastname: Fernández-Fresnedo
authors.forename: R
authors.initials: R
authors.lastname: Palomar
authors.forename: R
authors.initials: R
authors.lastname: Escallada
authors.forename: A L
authors.initials: AL
authors.lastname: Martín de Francisco
authors.forename: J G
authors.initials: JG
authors.lastname: Cotorruelo
authors.forename: J A
authors.initials: JA
authors.lastname: Zubimendi
authors.forename: S
authors.initials: S
authors.lastname: Sanz de Castro
authors.forename: J C
authors.initials: JC
authors.lastname: Ruiz
authors.forename: E
authors.initials: E
authors.lastname: Rodrigo
authors.forename: M
authors.initials: M
authors.lastname: Arias
mesh_terms: D000328:Adult; D001794:Blood Pressure / Q000502:physiology*; D016572:Cyclosporine / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006085:Graft Survival / Q000502:physiology*; D006650:Histocompatibility Testing; D006801:Humans; D006973:Hypertension / Q000209:etiology / Q000503:physiopathology*; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000276:immunology / Q000401:mortality / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012086:Reoperation; D012189:Retrospective Studies; D015996:Survival Rate; D017741:Survivors; D013997:Time Factors; D014184:Transplantation, Homologous
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine