Blood Pressure Treatment in Kidney Transplant Recipients - Can We Improve?

Abstract

<i>Background</i> - Hypertension in kidney transplant (KTx) recipients is common, affecting both patient and graft survival. Annual data from the Norwegian Renal Registry reveal that <50% of adult (>18 y) KTx recipients reach target blood pressure (BP) ≤130/80 mm Hg. The aim of this study was to identify the determinants of failure to achieve BP control.<br><br>

<i>Methods</i> - In conjunction with the 2018 annual data reporting, additional questions were added for recipients with BP >130/80 mm Hg (treating physician´s target BP for each patient, reasons for not achieving target, method of measurement).<br><br>

<i>Results</i> - Annual forms were received from 98% (3407 of 3486) of KTx recipients, with 1787 (52%) reporting a BP >130/80 mm Hg (“above-target” group). These recipients were older, mostly male, with higher body mass index and serum creatinine levels (<i>P</i> < 0.05) compared with patients with controlled hypertension (“on-target” group). Valid survey answers were available for 84% of the “above-target” group (Surv_resp) with no significant demographic differences versus nonresponders (Surv_nonresp). Among Surv_resp, 32% were under antihypertensive dose titration, whereas dose-limiting side effects were reported in 7%. Target BP was confirmed to 130/80 mm Hg for 60% of Surv_resp. In recipients for whom the treating physician set target BP >130/80 mm Hg, 51% did not reach these individual targets. The number of antihypertensive drugs was significantly higher in the “above-target” group versus “on-target” group (mean 2.1 ± 1.2 versus 1.8 ± 1.3) and 36% versus 25% used ≥3 antihypertensive drugs (<i>P</i> < 0.05). Automatic attended BP measurement was utilized by 51%.<br><br>

<i>Conclusions</i> - In KTx recipients, a higher BP target achievement seems possible, potentially in the range of 75%-80%.