title: Treatment efficacy of hypertension in kidney transplant recipients in the Netherlands.
abstract: BACKGROUND
  Hypertension in kidney transplant recipients jeopardises graft and patient survival. Guidelines suggest blood pressure targets of ≤130/80 mmHg and sodium intake <90 mmol/day.
  
  
  METHODS
  Since the efficacy of antihypertensive treatment among kidney transplant recipients is unknown, we analysed data on office-based blood pressure and use of antihypertensive drugs from the Netherlands Organ Transplant Registry on 5415 kidney transplant recipients. Additionally, we studied dosages, prevalence of treatment-resistant hypertension and 24-hour sodium excretion in 534 kidney transplant recipients from our centre to explore possibilities for therapy optimisation.
  
  
  RESULTS
  In patients registered in the Netherlands Organ Transplant Registry, median blood pressure was 134/80 mmHg (interquartile range 122-145/70-85). In 77.2%, the blood pressure was ≥130/80 mmHg; of these patients 10.4% had no registered use, 30.0% used one and 25.9% used ≥3 classes of antihypertensive agents. Parameters from our centre were comparable: 78.7% had a median blood pressure of ≥130/80 mmHg of whom 14.5% had no registered use of antihypertensives and 26.4% used ≥3 classes. Sub-maximal dosages were prescribed in 74.0% of the kidney transplant recipients with a blood pressure of ≥130/80 mmHg while using at least one antihypertensive agent. Treatment-resistant hypertension was present in 7.7%. Median 24-hour sodium excretion was 147 mmol/day (interquartile range 109-195).
  
  
  CONCLUSIONS
  This study suggests that therapeutic optimisation of antihypertensive treatment in kidney transplant recipients is, in theory, frequently possible by intensifying pharmacological treatment and by providing more advice on dietary sodium restrictions.
authors.affiliation: Department of Internal Medicine, Division of Nephrology - Renal Transplant Unit, Academic Medical Centre, Amsterdam, the Netherlands.
authors.forename: L C
authors.initials: LC
authors.lastname: Dobrowolski
authors.forename: F J
authors.initials: FJ
authors.lastname: Bemelman
authors.forename: K A M I
authors.initials: KA
authors.lastname: van Donselaar-van der Pant
authors.forename: A J
authors.initials: AJ
authors.lastname: Hoitsma
authors.forename: I J M
authors.initials: IJ
authors.lastname: ten Berge
authors.forename: C T P
authors.initials: CT
authors.lastname: Krediet
mesh_terms: D000328:Adult; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D004351:Drug Resistance; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D012042:Registries; D012964:Sodium / Q000652:urine
chemical_list: D000959:Antihypertensive Agents; D012964:Sodium