Hypertension after Kidney Transplantation: A Pathophysiologic Approach

被引:22
作者
Thomas, Beje [1 ]
Taber, David J. [2 ]
Srinivas, Titte R. [1 ]
机构
[1] Med Univ S Carolina, Div Nephrol, Charleston, SC 29425 USA
[2] Med Univ S Carolina, Div Transplant Surg, Charleston, SC 29425 USA
关键词
Kidney transplantation; Hypertension; Post-transplant hypertension; Ambulatory blood pressure monitoring; Self-blood pressure monitoring; Immunosuppression; Calcineurin inhibitor; Glucocorticoids; Donor risk factors; Recipient risk factors; Antihypertensives; Cardiovascular outcomes; Transplant renal artery stenosis; Hypertension management; Interstitial fibrosis/tubular atrophy; Pathophysiology of hypertension; BLOOD-PRESSURE CONTROL; CONVERTING ENZYME-INHIBITOR; ANGIOTENSIN-II BLOCKADE; TARGET ORGAN DAMAGE; LONG-TERM; CARDIOVASCULAR-DISEASE; ARTERIAL-HYPERTENSION; STEROID WITHDRAWAL; RENAL-TRANSPLANTATION; ALLOGRAFT SURVIVAL;
D O I
10.1007/s11906-013-0381-0
中图分类号
R6 [外科学];
学科分类号
1002 ; 100210 ;
摘要
Post-transplant hypertension is associated with decreased graft and patient survival and cardiovascular morbidity. Unfortunately, post-transplant hypertension is often poorly controlled. Important risk factors include immunosuppressive medications, complications of the transplant surgery, delayed graft function, rejection, and donor and recipient risk factors. The effects of immunosuppressive medications are multifactorial including increased vascular and sympathetic tone and salt and fluid retention. The immunosuppressive agents most commonly associated with hypertension are glucocorticoids and calcineurin inhibitors. Drug therapy for hypertension should be based on the comorbidities and pathophysiology. Evidence-based approaches to defining and treating hypertension in renal transplant recipients are predominantly extrapolated from large-scale studies performed in the general population. Thus, there continues to be a need for larger studies examining the pathophysiology, diagnosis and treatment of hypertension in renal transplant recipients.
引用
收藏
页码:458 / 469
页数:12
相关论文
共 107 条
[1]   Complications of renal transplantation [J].
Akbar, SA ;
Jafri, SZH ;
Amendola, MA ;
Madrazo, BL ;
Salem, R ;
Bis, KG .
RADIOGRAPHICS, 2005, 25 (05) :1335-1356
[2]   Pathogenesis and treatment of kidney disease and hypertension - Home blood pressure monitoring in CKD [J].
Andersen, MJ ;
Khawandi, W ;
Agarwal, R .
AMERICAN JOURNAL OF KIDNEY DISEASES, 2005, 45 (06) :994-1001
[3]  
Angeli F, 2012, EXPERT REV CARDIOVAS, V10, P1467, DOI [10.1586/ERC.12.151, 10.1586/erc.12.151]
[4]   Aortic stiffness, living donors, and renal transplantation [J].
Bahous, SA ;
Stephan, A ;
Blacher, J ;
Safar, ME .
HYPERTENSION, 2006, 47 (02) :216-221
[5]   Angiotensin-converting enzyme inhibitor-associated elevations in serum creatinine - Is this a cause for concern? [J].
Bakris, GL ;
Weir, MR .
ARCHIVES OF INTERNAL MEDICINE, 2000, 160 (05) :685-693
[6]   Blood Pressure J-Curve: Current Concepts [J].
Banach, Maciej ;
Aronow, Wilbert S. .
CURRENT HYPERTENSION REPORTS, 2012, 14 (06) :556-566
[7]   Posttransplant Hypertension: Multipathogenic Disease Process [J].
Barbari, Antoine .
EXPERIMENTAL AND CLINICAL TRANSPLANTATION, 2013, 11 (02) :99-108
[8]   Ambulatory Blood Pressure Monitoring in Renal Transplant Patients: Should It Be Routinely Performed? [J].
Beltran, S. ;
Crespo, J. ;
Kanter, J. ;
Alemany, B. ;
Gavela, E. ;
Avila, A. ;
Sancho, A. ;
Pallardo, L. .
TRANSPLANTATION PROCEEDINGS, 2010, 42 (08) :2868-2870
[9]   Cardiovascular Risk in Recipients With Kidney Transplants From Expanded Criteria Donors [J].
Blanca, L. ;
Jimenez, T. ;
Cabello, M. ;
Sola, E. ;
Gutierrez, C. ;
Burgos, D. ;
Lopez, V. ;
Hernandez, D. .
TRANSPLANTATION PROCEEDINGS, 2012, 44 (09) :2579-2581
[10]   NEPHRON UNDERDOSING - A PROGRAMMED CAUSE OF CHRONIC RENAL-ALLOGRAFT FAILURE [J].
BRENNER, BM ;
MILFORD, EL .
AMERICAN JOURNAL OF KIDNEY DISEASES, 1993, 21 (05) :66-72