Cor Vasa 2004, 45(10):467-471
Hypertension and cardiovascular disease following renal transplantation
- Klinika nefrologie, Institut klinické a experimentální medicíny, Praha, Česká republika
Aim:
Hypertension after renal transplantation is a known independent non-immune risk factor affecting the mortality and morbidity of renal graft recipients. Our 3-year study was designed to determine the prevalence of hypertension, success of its pharmacological management, and the incidence of cardiovascular disease following renal transplantation.
Method:
A total of 422 renal graft recipients were included into the study. Of this number, 310 individuals completed follow-up with a functioning graft from 3 to 36 months post-transplant. All individuals treated with antihypertensive agents were considered hypertensives while normotension was defined as a blood pressure (BP) lower than 140/90 mm Hg. Assessment included serum creatinine levels and antihypertensive therapy and cardiovascular disease in the patients' medical records.
Results:
A high prevalence of hypertension was found which rose from an initial 94% to 98%. The number of antihypertensive agents used was rising, with the use of triple and multiple combinations increasing from 17 % to 34 % of treated hypertensives. Success rates of drug therapy, i. e., the reaching of goal blood pressure levels, rose significantly (p < 0.01) from an initial 26% to 38% at 36 months. Mean serum creatinine levels increased significantly (p < 0.05) only in a subgroup of renal graft recipients with moderate to severe hypertension, characterized by triple to multiple drug antihypertensive combinations (increase from 150 ± 48 to 159 ± 55 µmol/L). During follow-up, cardiovascular disease-related morbidity was observed in 17 individuals (5.5%), however, 45 (14.6%) patients undergoing transplantation had a history of this disease. Thus, among the 310 renal graft recipients, cardiovascular disease was present in 62, mainly elderly individuals (20%). Mortality from cardiovascular disease was high, it was found in 25 out of the 56 patients who died (45%).
Conclusion:
Hypertension after renal transplantation is the most common non-immune risk factor for graft function and cardiovascular disease. A major role in preventing these complications is played by improved drug treatment of hypertension to achieve goal blood pressure levels.
Keywords: Renal transplantation; Hypertension; Cardiovascular disease
Published: October 1, 2004 Show citation