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Hypertension in Kidney Transplant Recipients: Where Are We Today?

  • Hypertension and the Kidney (RM Carey, Section Editor)
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Abstract

Purpose of Review

Cardiovascular disease is the leading cause of death and allograft loss among kidney transplant recipients, and hypertension is an independent risk factor for cardiovascular morbidity of this patient population. The etiology of hypertension is multifactorial, including pre-transplant volume overload, post-transplant recipient and donor-associated variables, and transplant-specific causes (immunosuppressive medications, allograft dysfunction and surgical complications such as transplant artery stenosis).

Recent Findings

No randomized controlled trials have assessed the optimal blood pressure targets and explored the best antihypertensive regimen for kidney transplant recipients. According to the large observational studies, it is reasonable to achieve a blood pressure goal of equal to or less than 130/80 mmHg in the long-term follow-up for minimizing the cardiovascular morbidity. The selection of antihypertensive agents should be based on the patient’s co-morbidities; however, the initial choice could be calcium channel blockers especially in the first few months of transplantation. In patients with cardiovascular indications of renin-angiotensin-aldosterone system inhibition, given the well-described benefits in diabetic and proteinuric patients, it is reasonable to consider the use of renin-angiotensin-aldosterone system inhibitors.

Summary

There is a need for future prospective trials in the transplant population to define optimal blood pressure goals and therapies.

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Authors and Affiliations

  1. Department of Nephrology, Bahcesehir University, 34734, Istanbul, Turkey

    Elif Ari

  2. Cardiovascular Risk Chair, University of Salamanca School of Medicine, Salamanca, Spain

    Francesco Fici

  3. Department of Nephrology, Hospital Universitario de Badajoz, and Cardiovascular Risk Chair, University of Salamanca School of Medicine, Salamanca, Spain

    Nicolas Roberto Robles

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  1. Elif Ari
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Ari, E., Fici, F. & Robles, N.R. Hypertension in Kidney Transplant Recipients: Where Are We Today?. Curr Hypertens Rep 23, 21 (2021). https://doi.org/10.1007/s11906-021-01139-4

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