Antihypertensive agents and renal transplantation

Abstract

Advances in the field of kidney transplantation have led to a significant increase in the life of renal allograft with 1-year graft survival rates of 93% to 99%. This increase in early graft survival has made it possible to observe the long-term morbidities that accompany renal transplantation. Studies correlating the reduction of arterial blood pressure with patient and graft survival as well as the risk of cardiovascular disease do not exist. The recommendations come from the general population and from comparative studies of hypertensive and normotensive kidney graft recipients. It is known that in the general population hypertension is a risk factor for chronic kidney disease but at the same time a risk factor for death, ischaemic heart disease, chronic heart failure and left ventricular hypertrophy. We must always have in mind that there are many similarities between a kidney graft recipient and a patient with chronic kidney disease. Renal transplant recipients represent a patient population with a very high risk for development of cardiovascular disease which has been identified as the leading cause of death in these patients. Of 18,482 deaths among renal allograft recipients, 38% had functioning renal allografts. Successful renal transplantation (Rt) can result in partial regression of left ventricular hypertrophy (LVH) if it is associated with hypertension (HTN) remission or if HTN is controlled by medications. Frequently post transplant HTN is associated with failure of LVH to regress. Transplant clinicians must choose antihypertensive agents that will provide their patients with maximum benefit from renal allograft and cardiovascular perspective. The target must always be long term patient and graft survival and acceptable quality of life. The antihypertensive drugs usually used after kidney transplantation are diuretics, calcium channel blockers, angiotensin converting enzyme inhibitors, angiotensin II receptor blockers and beta-blockers. Most emphasis is given lately to ACEIs/ARBs and beta-blockers because of their cardioprotecive effect.

Keywords: anti - hypertensive agents; hypertension; kidney transplantation.

Figure 1.. Five year follow up of systolic and diastolic blood pressure after kidney transplantation• 272 patients, period 1987-1995 (normal blood pressure considered to be systolic > 140 mmHg and diastolic > 90 mmHg) • Frequency on 7th pt day: 72.7%, on 5th year:67.6%

Figure 2.. Five year systolic blood pressure of patients with graft survival > 10 years and patients with graft survival <1 and > 10 years graft survival (p: 0.01)

Figure 3.. Graft survival in patients with normal blood pressure (red line) and hypertension (green line)

Figure 4.. The systolic blood pressure six months before and six months after valsartan treatment Vergoulas G, et al. Hippokratia 2001; 5:61-68

Figure 5.. Hb levels six months before and six months after valsartan treatment. Vergoulas G, et al. Hippokratia 2001; 5:61-68