Diagnostic and therapeutic challenges in implementing hypertension management after kidney transplantation
Issued Date
2024-01-01
Resource Type
ISSN
10624821
eISSN
14736543
Scopus ID
2-s2.0-85210473871
Pubmed ID
39513976
Journal Title
Current Opinion in Nephrology and Hypertension
Rights Holder(s)
SCOPUS
Bibliographic Citation
Current Opinion in Nephrology and Hypertension (2024)
Suggested Citation
Tantisattamo E., Ferrey A.J., Reddy U.G., Redfield R.R., Ichii H., Ammary F.A., Lau W.L. Diagnostic and therapeutic challenges in implementing hypertension management after kidney transplantation. Current Opinion in Nephrology and Hypertension (2024). doi:10.1097/MNH.0000000000001045 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/102301
Title
Diagnostic and therapeutic challenges in implementing hypertension management after kidney transplantation
Corresponding Author(s)
Other Contributor(s)
Abstract
Purpose of review Evidence for blood pressure (BP) measurement and hypertension management in kidney transplant recipients (KTR) remains lacking. Recent findings Accurate BP measurement technique is a critical component of hypertension management, and 24-h ambulatory BP monitoring remains the gold standard for diagnosis of hypertension in KTR. BP target at different periods posttransplant is uncertain, but likely higher than that in nontransplant patients given factors related to long-standing uremic milieu and kidney transplantation such as vascular calcification altering transplant renal hemodynamic and allograft perfusion and immunosuppression. Dividing BP target into immediate, early, and late posttransplant periods can guide differential diagnoses of hypertension and BP control with a target SBP less than 160mmHg in general and BP 115–135/65–85mmHg for adult KTR receiving pediatric kidneys during the immediate posttransplant period, 130/80mmHg during early and late posttransplant periods. Calcium channel blockers were shown to have favorable graft outcomes. Novel antihypertensive medications for resistant and refractory hypertension and device-based therapies are limited due to KTR’s ineligibility for participating in clinical trials. Summary In KTR, BP measurement and monitoring practice should follow the standard clinical practice guideline for nontransplant patients by considering posttransplant factors and immunosuppressive state. Novel treatment options required further studies.