Hypertension in the kidney transplant recipient.

  • H.M. W
  • Wadei H
  • Textor S
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Abstract

Elevated arterial blood pressure is common after kidney transplantation and contributes to shortened patient and allograft survivals and increased fatal and nonfatal cardiovascular events. Unfortunately, current evidence indicates that arterial blood pressure remains poorly controlled in kidney transplant recipients. One concern is how best to evaluate treated levels of arterial pressure in transplant recipients as office and clinic measurements often differ from blood pressure readings obtained using ambulatory blood pressure monitoring. Some antihypertensive drugs interact with immunosuppressive medications and adversely affect electrolyte balance and kidney function, which complicates the management of kidney transplant patients. Target blood pressure readings have been suggested by different guidelines, but patient-specific management plan is still lacking. Understanding the basic mechanisms responsible for the persistent hypertension after kidney transplantation is helpful in drafting patient-directed management plan that includes both pharmacologic and nonpharmacologic interventions to achieve target blood pressure control. In this review, we propose a multilayered treatment plan that addresses hypertension in both the early and late posttransplant periods, bearing in mind complications of antihypertensive medications, interactions with immunosuppressive drugs, patient comorbidities, and patient-specific cardiovascular risk factors in the posttransplant period.Copyright 2010 Elsevier Inc. All rights reserved.

Author-supplied keywords

  • *Hypertension/th [Therapy]
  • *Kidney Transplantation/ae [Adverse Effects]
  • *antihypertensive agent/dt [Drug Therapy]
  • *graft recipient
  • *hypertension/dt [Drug Therapy]
  • *hypertension/et [Etiology]
  • *kidney transplantation
  • *posttransplant hypertension/dt [Drug Therapy]
  • *posttransplant hypertension/et [Etiology] XT - b
  • Antihypertensive Agents/ae [Adverse Effects]
  • Antihypertensive Agents/tu [Therapeutic Use]
  • Blood Pressure
  • Drug Interactions
  • Humans
  • Hypertension/di [Diagnosis]
  • Hypertension/et [Etiology]
  • Hypertension/pp [Physiopathology]
  • Immunosuppressive Agents/tu [Therapeutic Use]
  • alpha adrenergic receptor blocking agent/ae [Adver
  • alpha adrenergic receptor blocking agent/dt [Drug
  • amlodipine/dt [Drug Therapy]
  • angiotensin receptor antagonist/ae [Adverse Drug R
  • angiotensin receptor antagonist/dt [Drug Therapy]
  • atenolol/ae [Adverse Drug Reaction]
  • atenolol/dt [Drug Therapy]
  • azathioprine/dt [Drug Therapy]
  • beta adrenergic receptor blocking agent/ae [Advers
  • beta adrenergic receptor blocking agent/dt [Drug T
  • blood pressure measurement
  • blood pressure regulation
  • bradycardia/si [Side Effect]
  • calcineurin inhibitor/dt [Drug Therapy]
  • calcium channel blocking agent/dt [Drug Therapy]
  • cardiovascular risk
  • clonidine/ae [Adverse Drug Reaction]
  • clonidine/dt [Drug Therapy]
  • comorbidity
  • constipation/si [Side Effect]
  • cyclosporin/dt [Drug Therapy]
  • dihydropyridine/dt [Drug Therapy]
  • diltiazem/ae [Adverse Drug Reaction]
  • diltiazem/dt [Drug Therapy]
  • dizziness/si [Side Effect]
  • edema/si [Side Effect]
  • electrolyte disturbance/si [Side Effect]
  • enalapril/ae [Adverse Drug Reaction]
  • enalapril/dt [Drug Therapy]
  • glomerulus filtration rate
  • graft survival
  • human
  • hyperkalemia/si [Side Effect]
  • hypertension/dt [Drug Therapy]
  • immunosuppressive agent/dt [Drug Therapy]
  • immunosuppressive treatment
  • kidney graft rejection/dt [Drug Therapy]
  • labetalol/ae [Adverse Drug Reaction]
  • labetalol/dt [Drug Therapy]
  • lisinopril/ae [Adverse Drug Reaction]
  • lisinopril/dt [Drug Therapy]
  • loop diuretic agent/ae [Adverse Drug Reaction]
  • loop diuretic agent/dt [Drug Therapy]
  • losartan/dt [Drug Therapy]
  • metabolic acidosis/si [Side Effect]
  • metoprolol/ae [Adverse Drug Reaction]
  • metoprolol/dt [Drug Therapy]
  • orthostatic hypertension/si [Side Effect]
  • orthostatic hypotension/si [Side Effect]
  • outcome assessment
  • posttransplant hypertension/dt [Drug Therapy]
  • ramipril/ae [Adverse Drug Reaction]
  • ramipril/dt [Drug Therapy]
  • renin angiotensin aldosterone system
  • review
  • risk factor
  • spironolactone/ae [Adverse Drug Reaction]
  • spironolactone/dt [Drug Therapy]
  • systolic blood pressure
  • tachycardia/si [Side Effect]
  • tacrolimus/dt [Drug Therapy]
  • thiazide diuretic agent/ae [Adverse Drug Reaction]
  • thiazide diuretic agent/dt [Drug Therapy]
  • treatment planning
  • uremia/si [Side Effect]
  • valsartan/dt [Drug Therapy]
  • verapamil/ae [Adverse Drug Reaction]
  • verapamil/dt [Drug Therapy]
  • white coat hypertension
  • xerostomia/si [Side Effect]

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Authors

  • Wadei H.M.

  • Hani M Wadei

  • Stephen C Textor

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