Antihypertensive therapy and blood pressure control in renal transplant recipients.

Renal transplant recipients are at high risk of cardiovascular diseases which represent,with infections, their major cause of excessive deaths. Immunosuppressive treatments are partly responsible leading to hypertension (HT), diabetes and hyperlipidemia.
Aim: This study analyses the blood pressure (BP) control in renal transplant recipients with functioning graft according to their current antihypertensive and immunosuppressive therapies. Data were collected for 211 patients (M:58%; F:42%) transplanted on average since 7.7 years (2-360 months). Mean age was 50 years (16–72), 84% had hypercholesterolemia (>1.9 g/l), 18% were diabetics and 24% were smokers. Seventy-eight % were under antihypertensive treatment.
Results: HT (mean OBP of 3 visits: >140 and/or >90 mmHg or treated) was observed in half of the untreated patients and uncontrolled in 80% of the treated ones. Ninety % of the treated hypertensive diabetic patients didn't reach target BP <130/80 mmHg. HT was significantly more frequent in patients whose glomerular filtration(GFR) was lower than the median value of GFR (55 ml/min/1.73 m2) of the population. Among treated patients, 48% had 1 drug, 29% had 2 drugs and 23% had 3 drugs or more. Beta-Blockers were the most prescribed even in association, while diuretics were less used since, even in 3 drugs therapy, only 60% received such class. Calcium inhibitors were not prescribed readily in first line but accounted for 47% in 2 drugs combinations. These observations were not related to the GFR level. Only 26% received an ACE inhibitor, their prescription decreases roughly in patients with impaired GFR. AII-RB concerned only 10% of therapies. Body weight, creatinine, graft survival and recipient's age were significantly related to SBP and DBP. In patients treated with cyclosporin, a highly significant relation (p=0.02) was found between BP and blood level of CsA, this was not observed in patients treated with tacrolimus .
Conclusion: HT was highly prevalent in renal transplant recipients( 88% of patients) even when treated. This study leads to reconsider habits of prescrition in view to improve the BP control by increasing the use of diuretics and to improve cardioprotection by using more often ACE inhibitors (when not contra-indicated) in that high cardiovascular risk population. As mentioned in literature, the effect of tacrolimus on BP appears lesser than the cyclosporine one.