Management of hypertension after transplantation

Abstract

The multiple causes of hypertension in kidney transplant recipients complicate management. Most patients have at least two, if not more, reasons for elevated blood pressure. Determining the relative significance of these multiple causes is difficult. The kidney transplant population has a greater prevalence of "correctable" forms of hypertension than the general population. Even though the situation is complex, physicians should, therefore, proceed with a diagnostic assessment of the possible contributions of the native kidneys, vascular stenosis, chronic rejection, and drug therapy. It is important to consider transplant artery stenosis in recipients of pediatric kidneys or living-related donor kidneys. Both surgery and angioplasty for such lesions, however, are associated with the risk of allograft loss. Native kidney nephrectomy can control hypertension in some patients, but investigations that are specific and sensitive for this cause are lacking. Both cyclosporine and prednisone can cause hypertension. The higher the dose of either drug, the more likely they will cause hypertension. Hypertension alone is usually insufficient reason for discontinuation of either prednisone or cyclosporine. Medical management of hypertension, when no surgically correctable form has been found, relies on antihypertensive medication. Non-pharmacological measures (exercise, sodium restriction, etc.) can be expected to work as well as they do in the general population. Calcium channel blockers seem to preserve allograft blood flow better than other antihypertensive medications. Diuretics, while effective, may aggravate the lipid abnormalities of patients.