The Evaluation and Therapeutic Management of Hypertension in the Transplant Patient

Abstract

Organ transplantation is the therapeutic option of choice in the appropriate patient with end-organ disease. A major comorbidity after the transplant is the development of hypertension which is a risk factor for cardiovascular disease. Cardiovascular disease is the most common cause of death in this population even when there is a functioning graft. It is essential to evaluate post-transplant hypertension not only in the office setting but at home and at night as well. Hence, the use of 24-h ambulatory blood pressure monitoring in both diagnosis and long-term care of this patient population is paramount. Factors involved in uncontrolled hypertension include the donor, recipient, and those specific to the transplant such as immunosuppressive drug exposure. The major offending immunosuppressive agents belong to the calcineurin inhibitor class. The therapy of post-transplant hypertension involves pharmaceutical and non-pharmaceutical interventions that should be tailored to the specific patient and type of transplant. There is clearly a need for more definitive data and quality studies in both the renal and non-renal transplant populations.

Hipertensão arterial no transplante renal: grande importância, mas poucas respostas

“…A HA após o TXR tem relação com a doença renal que determinou a perda da função dos rins primitivos e sua continuidade depende da doença que os acometeu. Como habitualmente não se indica nefrectomia dos rins primitivos, eles podem continuar a produzir substâncias vasopressoras que mantêm o processo hipertensivo, como a renina, ativando o sistema renina angiotensina aldosterona (SRAA) 9 .…”

“…Além disso, é de destaque a inércia dos médicos que acompanham esses pacientes, fenômeno reconhecido no tratamento da hipertensão primária, mesmo quando a PA está fora da meta pressórica 5,7,9,22,23 .…”

Arterial hypertension in kidney transplantation: huge importance, but few answers

“…AH after RTX is related to the kidney disease that determined the loss of function of the primitive kidneys and its continuity depends on the disease that affected them. As nephrectomy of primitive kidneys is not usually indicated, they may continue to produce vasopressor substances that maintain the hypertensive process, such as renin, activating the renin-angiotensin-aldosterone system (RAAS) 9 .…”

“…In addition, the inertia of physicians following these patients is highlighted, a phenomenon recognized in the treatment of primary hypertension, even when BP is outside the pressure target 5 , 7 , 9 , 22 , 23 .…”

Sudden hypertension in a kidney transplant recipient after a skiing accident

“…The detection of hypertension in previously non-hypertensive patients after transplant surgery is a frequent complication encountered during the long-term evaluation of kidney transplant recipients. The development of hypertension in such patients can be attributed to several factors, including immunosuppressive medication, acute rejection, and deterioration of kidney allograft function [1] . We present the case of a young patient with a sudden onset of new arterial hypertension due to an arteriovenous fistula (AVF) which had developed in the transplanted kidney after a skiing vacation.…”