Hypertension after Kidney Transplantation

Hypertension is one of the common complications after kidney transplantation that arises from various etiologies. Hypertension causes an accelerated atherosclerosis after transplantation and is a major factor for cardiovascular morbidity and mortality and chronic allograft failure. The aim of this study was to evaluate the prevalence and the role of common risk factors before and after transplantation on post transplant hypertension. All of the patients were visited monthly or every other month during the first year after transplantation. History and physical examination and necessary laboratory measurements were done (with special emphasis on blood pressure levels). Patients with blood pressure above 140/90 were diagnosed as hypertensive for whom antihypertensive agents were prescribed. Correlation was carried out between risk factors with development of hypertension which included age and gender of donor and recipient, recipient weight, hypertriglyceridemia, hypercholestremia, diabetes and cigarette smoking before and after transplantation. Past history of hypertension and allograft function with hypertension were also studied. Two hundred and seven (70.5 % males) patients were recruited in this study. Hypertension was cumulatively detected in 73.4, 76.5 and 84.5 % of cases after three, six and 12 months of transplantation. In all time intervals studied, no significant statistical correlation was found between age and gender of donors and recipients, recipient weight, history of diabetes, hypertriglyceridemia and cigarette smoking before and after transplantation. However, there was a significant correlation between development of post-transplantation hypertension with hypercholesterolemia after 6 and 12 months of transplantation (p<0.039 and <0.004), history of hypertension before transplantation after 12 months (p<0.043) as well as with function of allograft (p<0.04).This study revealed that hypertension after transplantation has a high prevalence and history of hypertension, function of allograft and hypercholesteremia after transplantation are risk factors. In addition, due to the high risk for cardiovascular morbidity and mortality associated with hypertension in these patients, it is advised that blood pressure must be measured routinely during the follow up periods and where possible the underlying cause be managed and hypertension should be aggressively managed by non-pharmacologic measures, minimization of doses of steroids and cyclosporine and pharmacologic therapy.