Assessment and management of hypertension in transplant patients

Matthew R. Weir, Ellen D. Burgess, James E. Cooper, Andrew Z. Fenves, David Goldsmith, Dianne McKay, Anita Mehrotra, Mark M. Mitsnefes, Domenic A. Sica, Sandra J Taler

Research output: Contribution to journalArticle

48 Citations (Scopus)

Abstract

Hypertension in renal transplant recipients is common and ranges from 50% to 80% in adult recipients and from 47% to 82% in pediatric recipients. Cardiovascular morbidity and mortality and shortened allograft survival are important consequences of inadequate control of hypertension. In this review, we examine the epidemiology, pathophysiology, and management considerations of post-transplant hypertension. Donor and recipient factors, acute and chronic allograft injury, and immunosuppressive medications may each explain some of the pathophysiology of post-transplant hypertension. As observed in other patient cohorts, renal artery stenosis and adrenal causes of hypertension may be important contributing factors. Notably, BP treatment goals for renal transplant recipients remain an enigma because there are no adequate randomized controlled trials to support a benefit from targeting lower BP levels on graft and patient survival. The potential for drug-drug interactions and altered pharmacokinetics and pharmacodynamics of the different antihypertensive medications need to be carefully considered. To date, no specific antihypertensive medications have been shown to be more effective than others at improving either patient or graft survival. Identifying the underlying pathophysiology and subsequent individualization of treatment goals are important for improving long-term patient and graft outcomes in these patients.

Original languageEnglish (US)
Pages (from-to)1248-1260
Number of pages13
JournalJournal of the American Society of Nephrology
Volume26
Issue number6
DOIs
StatePublished - Jun 1 2015

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Hypertension
Transplants
Graft Survival
Antihypertensive Agents
Allografts
Renal Artery Obstruction
Renal Hypertension
Immunosuppressive Agents
Drug Interactions
Epidemiology
Randomized Controlled Trials
Pharmacokinetics
Tissue Donors
Pediatrics
Morbidity
Kidney
Mortality
Wounds and Injuries
Therapeutics
Pharmaceutical Preparations

ASJC Scopus subject areas

  • Nephrology

Cite this

Weir, M. R., Burgess, E. D., Cooper, J. E., Fenves, A. Z., Goldsmith, D., McKay, D., ... Taler, S. J. (2015). Assessment and management of hypertension in transplant patients. Journal of the American Society of Nephrology, 26(6), 1248-1260. https://doi.org/10.1681/ASN.2014080834

Assessment and management of hypertension in transplant patients. / Weir, Matthew R.; Burgess, Ellen D.; Cooper, James E.; Fenves, Andrew Z.; Goldsmith, David; McKay, Dianne; Mehrotra, Anita; Mitsnefes, Mark M.; Sica, Domenic A.; Taler, Sandra J.

In: Journal of the American Society of Nephrology, Vol. 26, No. 6, 01.06.2015, p. 1248-1260.

Research output: Contribution to journalArticle

Weir, MR, Burgess, ED, Cooper, JE, Fenves, AZ, Goldsmith, D, McKay, D, Mehrotra, A, Mitsnefes, MM, Sica, DA & Taler, SJ 2015, 'Assessment and management of hypertension in transplant patients', Journal of the American Society of Nephrology, vol. 26, no. 6, pp. 1248-1260. https://doi.org/10.1681/ASN.2014080834
Weir MR, Burgess ED, Cooper JE, Fenves AZ, Goldsmith D, McKay D et al. Assessment and management of hypertension in transplant patients. Journal of the American Society of Nephrology. 2015 Jun 1;26(6):1248-1260. https://doi.org/10.1681/ASN.2014080834
Weir, Matthew R. ; Burgess, Ellen D. ; Cooper, James E. ; Fenves, Andrew Z. ; Goldsmith, David ; McKay, Dianne ; Mehrotra, Anita ; Mitsnefes, Mark M. ; Sica, Domenic A. ; Taler, Sandra J. / Assessment and management of hypertension in transplant patients. In: Journal of the American Society of Nephrology. 2015 ; Vol. 26, No. 6. pp. 1248-1260.
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