Survival of patient and transplant
has improved tremendously. Despite this fact cardiovascular
disease continues to be the most common cause of death and transplant loss
after kidney transplant. A major risk factor for this is hypertension, i.e. high Blood Pressure (BP). Hypertension is almost
ubiquitous in kidney transplant recipients. Hypertension negatively affects
transplant and patient survival outcomes. Its best management requires careful
analysis of causes and close monitoring of therapies.
The two classical immunosuppressant
medicines tacrolimus and cyclosporine used after organ transplant
to reduce risk of donor organ rejection are implicated as major cause for
hypertension in patients after transplantation.
BP measurements typically are performed in the office by a medical assistant,
nurse, or physician. One of the studies revealed that the presence of the
physician at the time of BP measurement caused BP to increase by 3-4 mm Hg. Hence,
alternatives to office BP readings include self BP measurement (SBPM) at home,
and ambulatory BP monitoring (ABPM) are now recommended. ABPM is regarded as a
more sensitive method for diagnosing hypertension than sole reliance on office
BP in kidney transplant recipients.
Though there are no sufficient clinical
evidences, lifestyle modifications, such as weight loss, increasing regular
exercise, and sodium restriction are advised to transplant patients.
Antihypertensive therapy in these patients is beneficial as it helps in
preserving the functions of kidney and decreasing the risk of heart diseases. A
universal algorithm for the management of posttransplant hypertension is not
available at present. A recent publication in the American Journal of Kidney
Disease (AJKD) reviewed anti-hypertensive medications for patients after kidney
Patients with established heart disease
and diabetes should receive the class of BP lowering drugs called beta-blockers
in the perioperative period. The drug called hydralazine is good for short term
use in hospitalized patients. Calcium channel blockers may be recommended early
management of hypertension is a life saver. It helps to attain better
transplant and patient survival outcomes. Therapy should be goal oriented and
care should be highly customised, i.e. tailored to the need of the individual.
Source: Hypertension After Kidney Transplant. American Journal of Kidney Diseases, Volume 57, Issue 2, Pages 331-341, February 2011.