TY - JOUR
T1 - Hypertension in kidney transplantation: a consensus statement of the 'hypertension and the kidney' working group of the European Society of Hypertension
AU - Halimi, Jean-Michel
AU - Ortiz, Alberto
AU - Sarafidis, Pantelis A.
AU - Mallamaci, Francesca
AU - Wuerzner, Grégoire
AU - Pisano, Anna
AU - London, G. rard
AU - Persu, Alexandre
AU - Rossignol, Patrick
AU - Sautenet, B. nédicte
AU - Ferro, Charles
AU - Boletis, John
AU - Kanaan, Nada
AU - Vogt, Liffert
AU - Bolignano, Davide
AU - Burnier, Michel
AU - Zoccali, Carmine
N1 - Publisher Copyright: Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2021/8/1
Y1 - 2021/8/1
N2 - Hypertension is common in kidney transplantation recipients and may be difficult to treat. Factors present before kidney transplantation, related to the transplantation procedure itself and factors developing after transplantation may contribute to blood pressure (BP) elevation in kidney transplant recipients. The present consensus is based on the results of three recent systematic reviews, the latest guidelines and the current literature. The current transplant guidelines, which recommend only office BP assessments for risk stratification in kidney transplant patients should be reconsidered, given the presence of white-coat hypertension and masked hypertension in this population and the better prediction of adverse outcomes by 24-h ambulatory BP monitoring as indicated in recent systematic reviews. Hypertension is associated with adverse kidney and cardiovascular outcomes and decreased survival in kidney transplant recipients. Current evidence suggests calcium channel blockers could be the preferred first-step antihypertensive agents in kidney transplant patients, as they improve graft function and reduce graft loss, whereas no clear benefit is documented for renin-angiotensin system inhibitor use over conventional treatment in the current literature. Randomized control trials demonstrating the clinical benefits of BP lowering on kidney and major cardiovascular events and recording patient-related outcomes are still needed. These trials should define optimal BP targets for kidney transplant recipients. In the absence of kidney transplant-specific evidence, BP targets in kidney transplant recipients should be similar to those in the wider chronic kidney disease population.
AB - Hypertension is common in kidney transplantation recipients and may be difficult to treat. Factors present before kidney transplantation, related to the transplantation procedure itself and factors developing after transplantation may contribute to blood pressure (BP) elevation in kidney transplant recipients. The present consensus is based on the results of three recent systematic reviews, the latest guidelines and the current literature. The current transplant guidelines, which recommend only office BP assessments for risk stratification in kidney transplant patients should be reconsidered, given the presence of white-coat hypertension and masked hypertension in this population and the better prediction of adverse outcomes by 24-h ambulatory BP monitoring as indicated in recent systematic reviews. Hypertension is associated with adverse kidney and cardiovascular outcomes and decreased survival in kidney transplant recipients. Current evidence suggests calcium channel blockers could be the preferred first-step antihypertensive agents in kidney transplant patients, as they improve graft function and reduce graft loss, whereas no clear benefit is documented for renin-angiotensin system inhibitor use over conventional treatment in the current literature. Randomized control trials demonstrating the clinical benefits of BP lowering on kidney and major cardiovascular events and recording patient-related outcomes are still needed. These trials should define optimal BP targets for kidney transplant recipients. In the absence of kidney transplant-specific evidence, BP targets in kidney transplant recipients should be similar to those in the wider chronic kidney disease population.
UR - http://www.scopus.com/inward/record.url?scp=85111788612&partnerID=8YFLogxK
U2 - https://doi.org/10.1097/HJH.0000000000002879
DO - https://doi.org/10.1097/HJH.0000000000002879
M3 - Article
C2 - 34054055
SN - 0263-6352
VL - 39
SP - 1513
EP - 1521
JO - Journal of Hypertension
JF - Journal of Hypertension
IS - 8
ER -