title: Assessment and management of hypertension in transplant patients.
abstract: Hypertension in renal transplant recipients is common and ranges from 50% to 80% in adult recipients and from 47% to 82% in pediatric recipients. Cardiovascular morbidity and mortality and shortened allograft survival are important consequences of inadequate control of hypertension. In this review, we examine the epidemiology, pathophysiology, and management considerations of post-transplant hypertension. Donor and recipient factors, acute and chronic allograft injury, and immunosuppressive medications may each explain some of the pathophysiology of post-transplant hypertension. As observed in other patient cohorts, renal artery stenosis and adrenal causes of hypertension may be important contributing factors. Notably, BP treatment goals for renal transplant recipients remain an enigma because there are no adequate randomized controlled trials to support a benefit from targeting lower BP levels on graft and patient survival. The potential for drug-drug interactions and altered pharmacokinetics and pharmacodynamics of the different antihypertensive medications need to be carefully considered. To date, no specific antihypertensive medications have been shown to be more effective than others at improving either patient or graft survival. Identifying the underlying pathophysiology and subsequent individualization of treatment goals are important for improving long-term patient and graft outcomes in these patients.
authors: Division of Nephrology, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland; mweir@medicine.umaryland.edu.
authors: Matthew R
authors: MR
authors: Weir
authors: Division of Renal Medicine, Department of Medicine, University of Calgary, Calgary, Alberta, Canada;
authors: Ellen D
authors: ED
authors: Burgess
authors: Division of Renal Disease and Hypertension, Department of Medicine, University of Colorado, Denver, Colorado;
authors: James E
authors: JE
authors: Cooper
authors: Division of Nephrology, Department of Medicine, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts;
authors: Andrew Z
authors: AZ
authors: Fenves
authors: Division of Cardio-Renal Medicine, St. Thomas and Guy's Hospital, London, United Kingdom;
authors: David
authors: D
authors: Goldsmith
authors: Division of Nephrology, Department of Medicine, University of California, San Diego, San Diego, California;
authors: Dianne
authors: D
authors: McKay
authors: Division of Nephrology, Department of Medicine, Mount Sinai School of Medicine, New York, New York;
authors: Anita
authors: A
authors: Mehrotra
authors: Division of Nephrology, Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio;
authors: Mark M
authors: MM
authors: Mitsnefes
authors: Division of Nephrology, Department of Medicine, Virginia Commonwealth University, Richmond, Virginia; and.
authors: Domenic A
authors: DA
authors: Sica
authors: Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota.
authors: Sandra J
authors: SJ
authors: Taler
mesh_terms: D000328:Adult; D000367:Age Factors; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001795:Blood Pressure Determination; D002648:Child; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology*; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000379:methods; D008297:Male; D011379:Prognosis; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents
keywords: aldosterone; angiotensin; blood pressure; hypertension; transplantation
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