Management of Hypertension in Renal Transplant Patients: A Comprehensive Review of Nonpharmacologic and Pharmacologic Treatment Strategies

Dunn, Brianne L.; Teusink, Ashley; Taber, David J.; Hemstreet, Brian A.; Uber, L; Weimert, Nicole A.

doi:10.1345/aph.1p004

Cited by 9 publications

(9 citation statements)

References 54 publications

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“…ARB can be used as an alternative in cases of CKD and post-transplant erythrocytosis. All of the above indications for specific anti hypertensive regimens for various clinical entities have nicely been summarized by Dunn et al as well (29).…”

Section: Hypertensionmentioning

confidence: 99%

“…In the era of CNIs, roughly 60-90% of patients seem to be afflicted with hypertension (29). The etiology of hypertension is likely multifactorial and management needs to be more nuanced.…”

Section: Hypertensionmentioning

confidence: 99%

“…Since calcium channel blockers are used early in transplant, they can be considered first-line therapy (29). ACE inhibitors are second line therapy and have been shown safe to use 6-12 weeks after transplant.…”

Section: Hypertensionmentioning

confidence: 99%

“…ACE inhibitors are second line therapy and have been shown safe to use 6-12 weeks after transplant. For de novo initiation, it is recommended that therapy be started at least 6 weeks post-transplant (29). A recent randomized study comparing nifedipine and lisinopril demonstrated improved kidney outcomes (lower creatinine and improved GFR at 2 years) with the use of nifedipine (28).…”

Section: Hypertensionmentioning

confidence: 99%

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Medical Management of the Kidney Transplant Recipient

Patel¹,

Lee²

2012

Current Concepts in Kidney Transplantation

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Section: Hypertensionmentioning

confidence: 99%

“…In the era of CNIs, roughly 60-90% of patients seem to be afflicted with hypertension (29). The etiology of hypertension is likely multifactorial and management needs to be more nuanced.…”

Section: Hypertensionmentioning

confidence: 99%

Section: Hypertensionmentioning

confidence: 99%

Section: Hypertensionmentioning

confidence: 99%

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Medical Management of the Kidney Transplant Recipient

Patel¹,

Lee²

2012

Current Concepts in Kidney Transplantation

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“…However, the optimal medical regimen in this population remains undefined. Factors to be considered in prescribing AHMs include comorbid conditions that are indications for particular agents, or drug interactions with immunosuppressive therapy …”

Section: Introductionmentioning

confidence: 99%

Impacts of center and clinical factors in antihypertensive medication use after kidney transplantation

Koraishy

Yamout

Naik

et al. 2020

Clinical Transplantation

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Hypertension guidelines recommend calcium channel blockers (CCBs), thiazide diuretics, and angiotensin‐converting‐enzyme inhibitors/angiotensin receptor blockers (ACEi/ARBs) as first‐line agents to treat hypertension. Hypertension is common among kidney transplant (KTx) recipients, but data are limited regarding patterns of antihypertensive medication (AHM) use in this population. We examined a novel database that links national registry data for adult KTx recipients (age > 18 years) with AHM fill records from a pharmaceutical claims warehouse (2007‐2016) to describe use and correlates of AHM use during months 7‐12 post‐transplant. For patients filling AHMs, individual agents used included: dihydropyridine (DHP) CCBs, 55.6%; beta‐blockers (BBs), 52.8%; diuretics, 30.0%; ACEi/ARBs, 21.1%; non‐DHP CCBs, 3.0%; and others, 20.1%. Both BB and ACEi/ARB use were significantly lower in the time period following the 2014 Eighth Joint National Committee (JNC‐8) guidelines (2014‐2016), compared with an earlier period (2007‐2013). The median odds ratios generated from case‐factor adjusted models supported variation in use of ACEi/ARBs (1.51) and BBs (1.55) across transplant centers. Contrary to hypertension guidelines for the general population, KTx recipients are prescribed relatively more BBs and fewer ACEi/ARBs. The clinical impact of this AHM prescribing pattern warrants further study.

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Hypertension after Kidney Transplantation: A Pathophysiologic Approach

2013

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Post-transplant hypertension is associated with decreased graft and patient survival and cardiovascular morbidity. Unfortunately, post-transplant hypertension is often poorly controlled. Important risk factors include immunosuppressive medications, complications of the transplant surgery, delayed graft function, rejection, and donor and recipient risk factors. The effects of immunosuppressive medications are multifactorial including increased vascular and sympathetic tone and salt and fluid retention. The immunosuppressive agents most commonly associated with hypertension are glucocorticoids and calcineurin inhibitors. Drug therapy for hypertension should be based on the comorbidities and pathophysiology. Evidence-based approaches to defining and treating hypertension in renal transplant recipients are predominantly extrapolated from large-scale studies performed in the general population. Thus, there continues to be a need for larger studies examining the pathophysiology, diagnosis and treatment of hypertension in renal transplant recipients.

show abstract

Management of Hypertension in Renal Transplant Patients: A Comprehensive Review of Nonpharmacologic and Pharmacologic Treatment Strategies

Cited by 9 publications

References 54 publications

Medical Management of the Kidney Transplant Recipient

Medical Management of the Kidney Transplant Recipient

Impacts of center and clinical factors in antihypertensive medication use after kidney transplantation

Hypertension after Kidney Transplantation: A Pathophysiologic Approach

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