Hypertension after kidney transplantation: Are treatment guidelines emerging?

Abstract

Despite improvements in patient and graft survival, transplant patients continue to die prematurely due to accelerated cardiovascular disease. Calcineurin inhibitors and corticosteroids induce hypertension in most transplant recipients. Post-transplant hypertension appears to be a major risk factor for graft and patient survival. Hypertension following renal transplantation must be treated as strictly as in patients with essential hypertension, diabetes mellitus or chronic renal failure. An adequate treatment goal may be a blood pressure of < 135/85 mmHg. A strong case can be made for treating hypertensive renal transplant recipients with a CCA. In the early post-transplant period, antihypertensive treatment should in our opinion normally include a CCA. We are not willing to go as far as Dudley in his recent editorial in Transplantation [31], where he concludes that 'a strong case can be made for adding controlled release nifedipine to the initial drug regimen of all renal transplant recipients receiving cyclosporin-based immunosuppression, whether hypertensive or not'. In any case, we propose that the time has come for the ERA/EDTA to develop guidelines for the treatment of hypertension after renal transplantation.