Hypertension in the kidney transplant recipient

被引:52
|
作者
Wadei, Hani M. [1 ]
Textor, Stephen C. [2 ]
机构
[1] Mayo Clin Jacksonville, Coll Med, Dept Transplantat, Jacksonville, FL 32224 USA
[2] Mayo Clin, Coll Med, Div Nephrol & Hypertens, Rochester, MN USA
关键词
AMBULATORY BLOOD-PRESSURE; RENIN-ANGIOTENSIN SYSTEM; RENAL-ARTERY STENOSIS; PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY; LAPAROSCOPIC BILATERAL-NEPHRECTOMY; CYCLOSPORINE-INDUCED HYPERTENSION; CONVERTING ENZYME-INHIBITOR; SYMPATHETIC-NERVE ACTIVITY; CALCIUM-CHANNEL BLOCKERS; LONG-TERM;
D O I
10.1016/j.trre.2010.02.001
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Elevated arterial blood pressure is common after kidney transplantation and contributes to shortened patient and allograft survivals and increased fatal and nonfatal cardiovascular events. Unfortunately, current evidence indicates that arterial blood pressure remains poorly controlled in kidney transplant recipients. One concern is how best to evaluate treated levels of arterial pressure in transplant recipients as office and clinic measurements often differ from blood pressure readings obtained using ambulatory blood pressure monitoring. Some antihypertensive drugs interact with irnmunosuppressive medications and adversely affect electrolyte balance and kidney function, which complicates the management of kidney transplant patients. Target blood pressure readings have been suggested by different guidelines, but patient-specific management plan is still lacking. Understanding the basic mechanisms responsible for the persistent hypertension after kidney transplantation is helpful in drafting patient-directed management plan that includes both pharmacologic and nonpharmacologic interventions to achieve target blood pressure control. In this review, we propose a multilayered treatment plan that addresses hypertension in both the early and late posttransplant periods, bearing in mind complications of antihypertensive medications, interactions with immunosuppressive drugs, patient comorbidities, and patient-specific cardiovascular risk factors in the posttransplant period. (C) 2010 Elsevier Inc. All rights reserved.
引用
收藏
页码:105 / 120
页数:16
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