Hypertension after kidney transplantation: impact, pathogenesis and therapy.
Hypertension (HTN) contributes to the high incidence of cardiovascular disease mortality as well as chronic allograft nephropathy (CAN) and late graft failure in renal transplant recipients. The mechanisms are complex and may involve pathogenic factors attributable to the host, allograft, and immunosuppressive drugs. Calcium channel blockers should be used to ameliorate the nephrotoxicity of calcineurin inhibitors in the early years after transplantation. Angiotensin-converting enzyme inhibitors and angiotensin-2 type-1 receptor blockers are safe and effective, have antiproteinuric effects, slow the progression of CAN, and may provide survival benefits. Diuretics and/or beta-adrenergic receptor blockers are frequently added in combination regimen. Appropriate adjustment of the immunosuppressive drugs should also be considered for the long-term care of kidney recipients with HTN.
Zhang
Rubin
R
Section of Nephrology, Department of Medicine, Louisianna State University Health Sciences Center, New Orleans 70112-2822, USA.
Leslie
Bruce
B
Boudreaux
J Philip
JP
Frey
Daniel
D
Reisin
Efrain
E
D000959:Antihypertensive Agents / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000401:mortality; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology*; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000401:mortality; D012307:Risk Factors
D000959:Antihypertensive Agents; D007166:Immunosuppressive Agents