Post transplant hypertension - a common problem of allograft recipients

The overall incidence of post transplant hypertension after long term follow-up is about 50% and it is one of the important factors that affect the quality of life of the allograft recipient. The causes of hypertension in kidney transplant recipients are multifactorial and often needs a complicated management. Most patients have at least two, if not more reasons for elevated blood pressure. Determining the relative significance of these multiple causes is difficult. The kidney transplant population has a greater prevalence of correctable forms of hypertension than the general population. The possible contributors of post transplant hypertension are diseased native kidney, vascular stenosis, chronic rejection and drug therapy. It is important to consider transplant artery stenosis in recipients of paediatric kidneys or living related donor kidneys. Both surgery and angioplasty for such lesions, however, are associated with the risk of allograft loss. Native kidney nephrectomy can control hypertension in some patients, but investigations that are specific and sensitive for this cause are lacking. Both cyclosporine and prednisolone can cause hypertension. The higher the dose of either drug, the more likely they will cause hypertension. Hypertension alone is usually insufficient reason for discontinuation of either prednisolone or cyclosporine. Medical management of hypertension, when no surgically correctable form has been found, relies on antihypertensive medications. Non pharmacological measure (exercise, sodium restriction etc) can be expected to work as they do in the general population. Calcium channel blockers seem to preserve allograft blood flow better than other antihypertensive medications. Diuretics, while effective may aggravate the lipid abnormalities of patients.