A practical guide to the management of hypertension in renal transplant recipients

Hypertension as well as hypotension can be harmful to a newly transplanted renal allograft. Elevated blood pressure is also a major risk factor for ca rdiovascular death, which is a frequent occurrence despite successful renal transplantation. Renal artery stenosis, immunosuppressive drugs, chronic r ejection, retained native kidneys, and excessive extracellular fluid volume may all contribute to post-transplant hypertension. Antihypertensive agent s are widely used in the management of post-transplant hypertension. Carefu l clinical judgement and knowledge of the pharmacology, pharmacodynamics, p harmacokinetics, adverse drug reaction profiles, potential contraindication s, and drug-drug interactions of antihypertensive agents are important when therapy with antihypertensive drugs is initiated in renal transplant recip ients. Since blood pressure elevation in any individual is determined by a large number of hormonal and neuronal systems, the effect of antihypertensi ve agents on the allograft should be considered a critical factor in the ma nagement of hypertension in renal transplant recipients. Most renal transpl ant recipients have other risk factors for premature cardiovascular death s uch as diabetes mellitus, hypercholesterolemia, insulin resistance, obesity , left ventricular hypertrophy and ischaemic heart disease. Initial antihyp ertensive therapy should be tailored individually according to the patient' s risk factors. A realistic therapeutic goal for bleed pressure management in the initial postoperative state is a systolic blood pressure <160mm Hg a nd a diastolic blood pressure <90mm Hg with lower pressure targets becoming applicable late post-transplantation.