RELATIONSHIPS BETWEEN ARTERIAL-HYPERTENSION AND RENAL-ALLOGRAFT SURVIVAL IN AFRICAN-AMERICAN PATIENTS

In previous studies, we showed that in African-American patients arter ial hypertension during the first 6 months after transplantation is as sociated with a high risk of renal allograft loss. In this study, we s ought to examine the relationships between pretransplant blood pressur e (preBP), blood pressure early after transplantation (postBP), and al lograft function and survival, The study included 116 African-American recipients of first cadaveric renal allografts followed for 64 +/- 40 months, Prior to transplantation, 78% of the patients required antihy pertensive medications and 59% had poorly controlled BP (average mean arterial pressure, greater than or equal to 107 mm Hg), Blood pressure levels increased significantly during the first month posttransplant, particularly in patients with poorly controlled preBP. During the fir st 6 months posttransplant, 95% of patients required antihypertensive drugs; after the transplant, patients required significantly more and higher doses of antihypertensives compared with pretransplant. In 38% of the patients, postBP remained high despite therapy. The level of po stBP correlated with the patient's weight pretransplant and with the l evel of preBP, Pretransplant BP correlated with postBP 1 month after t ransplantation (r = 0.4, P < 0.0001), and 70% of the patients with poo rly controlled postBP had uncontrolled preBP. Patients with poorly con trolled preBP had worse graft survival than patients with well-control led preBP (P = 0.03 by Cox regression), Furthermore, compared with pat ients with well-controlled postBP, patients with high postBP had highe r serum creatinine at 10 days (P = 0.04) and at 6 months (P = 0.0004) posttransplant; these patients had reduced graft survival (P = 0.0006 by Cox), We found no objective evidence of differences in patient comp liance between individuals with high postBP and those with well-contro lled postBP. This study confirms the association between high postBP a nd reduced renal allograft survival in African-American patients, In a ddition, these results show that the level of preBP can be used to ide ntify patients at high risk of developing severe hypertension immediat ely after transplantation and those at risk for renal allograft failur e. (C) 1997 by the National Kidney Foundation, Inc.