Management of hypertension in the transplant patient.

The development of hypertension after kidney transplantation is common. Hypertension, defined as a blood pressure greater than 140/90 mm Hg, is associated with an increased risk for both acute rejection and lower graft and patient survival. The pathogenesis is multifactorial, and optimal therapy has yet to be clearly defined. Despite the restoration of kidney function and improvement of intravascular volume control with kidney transplantation, the problems of posttransplant hypertension remain substantial. The incidence of posttransplant hypertension is variable, but considerable. Most studies report incidence rates between 60% and 80%. In one crosssectional study of 409 stable kidney allograft recipients, the incidence of hypertension was 77.3%, with hypertension defined as a blood pressure greater than 150/90 mm Hg. In this analysis, the majority of patients (68.9%) required multiple antihypertensive drugs. Similarly, in pediatric kidney transplant recipients, a recent database analysis described the incidence of posttransplant hypertension at 74%. National guidelines define hypertension as greater than 140/90 mm Hg, which is also the typical definition used in most studies of patients with kidney transplants. However, national guidelines also recommend treatment goals lower than 130/80 mm Hg for the general population with diabetes or estimated glomerular filtration rate (GFR) below 60 mL/min/1.73 m. Thus, the true prevalence of posttransplant hypertension using this reference range is likely in excess of 95%. Given the fact that transplant centers rarely report their data on achieved levels of blood pressure control, coupled with the fact that there is decreased exposure time to their transplant center physicians (as their patients return to their primary nephrologist or primary care physicians), the current status of control rates of hypertension is unknown. This lack of data is concerning, as a major cause of