Management of hypertension and factors affecting its control in Jordanian renal transplant recipients

Background Hypertension affects 70-90 % of all kidney transplant recipients. It is associated with poor graft survival and is a contributing factor to the increased cardiovascular mortality. The reasons for the insufficient blood pressure control in transplanted patients have not been thoroughly investigated. Objective To evaluate the extent of blood pressure control in Jordanian hypertensive renal transplant recipients and to assess factors associated with such control. Setting Three outpatient renal transplant clinics in Amman. Method A cross-sectional observational study including 181 patients. We have considered blood pressure < 130/80 mm Hg as controlled hypertension. Bivariate and multivariate logistic regression analyses were used to determine clinical factors associated with achievement of blood pressure control. Main outcome measures Proportion of patients who achieved hypertension control and clinical factors associated with good blood pressure control. Results Mean systolic blood pressure was 128.6 +/- A 16.3 mm Hg and mean diastolic blood pressure was 82.8 +/- A 11.5 mm Hg. Blood pressure control was achieved only in 58 % of patients. The most commonly prescribed antihypertensives were calcium channel blockers (58 %) followed by beta-blockers (44 %). In bivariate analysis, female gender (p = 0.017) and creatinine clearance (p = 0.002) were positively associated, while number of antihypertensive medications was inversely associated (p = 0.04) with achievement of blood pressure control. After including these factors in multivariate logistic regression analysis, only creatinine clearance remained independently associated with hypertension control (odds ratio, OR 1.04; 95 % confidence interval [CI] 1.01-1.06; p = 0.003). Conclusion Blood pressure control among renal transplant recipients in Jordan was found to be inadequate. The only factor found to be independently associated with adequate blood pressure control was creatinine clearance.