Risk of cardiovascular disease associated with refractory hypertension in renal transplant recipients.

BACKGROUND: Hypertension is common after renal transplantation, affecting as many as 80% of recipients. It is generally accepted that hypertension is associated with poor graft survival and reduced life expectancy because of increased cardiovascular risk factors. The prevalence of refractory hypertension in renal transplant recipients is unknown, and could be associated with a poor prognosis. OBJECTIVE: To investigate the effects of refractory hypertension on cardiovascular disease (CVD) after renal transplantation in 486 patients with grafts functioning for longer than 1 year. PATIENTS AND METHODS: Patients were classified into 2 groups: (1) 57 with refractory hypertension, that is, systolic blood pressure 130 mm Hg or greater or diastolic blood pressure 80 mm Hg or greater, and receiving treatment with at least 3 drugs, one of which was a diuretic; and (2) the remaining 429 patients. Patient and graft survival, and posttransplantation CVD were analyzed. RESULTS: Refractory hypertension was associated with male sex (82.5% vs 66.5% [P<.01]), poor renal function (mean [SD] serum creatinine concentration 2.2 [1.2] mg/dL vs 1.6 [0.6] mg/dL; Modification of Diet in Renal Disease score 39.2 [20.0] mL/min/1.73 m2 vs 49.2 [18.0] mL/min/1.73 m2 [P=.000]; and steroid therapy (94.7% vs 79.0% [P=.001]). In the group with refractory hypertension, 5-year patient and graft survival rates were lower, and the incidence of posttransplantation CVD was greater (relative risk, 1.7; 95% confidence interval, 1.05-2.18; P=.03). CONCLUSION: Refractory hypertension is an independent risk factor for increased cardiovascular morbidity and mortality in renal transplant recipients.

Clinical and epidemiological characteristics of refractory hypertension in renal transplant patients.

Hypertension is common following renal transplantation, affecting up to 80% of recipients. It is generally accepted that hypertension is associated with poor graft survival and reduced life expectancy, contributing to increased cardiovascular risk factors and mortality rates. The prevalence of refractory hypertension among renal transplant patients is unknown; it may be associated with a worse prognosis. The aim of our study was to determine the prevalence of refractory hypertension among 529 stable renal transplant recipients and to describe its clinical and epidemiological features. We divided this population into 4 groups to make comparisons: normotensive (n = 82), controlled hypertension (n = 228), uncontrolled hypertension but not refractory (n = 183), and refractory hypertension (n = 36) as defined by a systolic blood pressure >or= 140 mm Hg and/or a diastolic blood pressure >or= 90 mm Hg among patients treated with 3 or more drugs (1 of them being a diuretic). The proportion of patients with refractory hypertension in our transplant unit was 6.8%. The main characteristics of patients with refractory hypertension versus normotensive patients were: mainly systolic hypertension (152.5 +/- 10.32 vs 121.6 +/- 9.26 mm Hg; P < .012), elderly age (59.47 vs 48.33 years; P < .000), diabetes (36.2% vs 1.2%; P < .000), poorer renal function as measured by glomerular filtration rate (36.15 +/- 20.41 vs 56.12 +/- 15.75 mL/min/1.73 m(2); P < .004), higher 24-hour urinary protein excretion (2.55 +/- 2.61 vs 0.5 +/- 0.8 g; P < .003), and steroid treatment (47.2% vs 23.2%; P < .000). The results of this study may help identify the clinical and epidemiological factors which correlated with refractory hypertension for future interventional applications to reduce the morbidity/mortality among the renal transplant population.

La estenosis no significativa de arteriarenal en riñón único no contraindica la colocación de una prótesis endovascular aórtica / No disponible

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