Arterial hypertension in kidney transplantation – modern therapy strategy

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Abstract

Arterial hypertension (AH) is the most common cardiovascular risk factor in kidney transplant recipients. Post-transplant hypertension refers to a persistent increase in blood pressure (BP) or a normotensive state during antihypertensive therapy after successful kidney transplantation. Post-transplant hypertension, being a leading risk factor for coronary artery disease (CAD), stroke and congestive heart failure in kidney transplant recipients, is accompanied by a decrease in survival, mainly due to the addition of CAD. Thus, kidney transplantation and hypertension, according to an analysis of the French national database, increase the risk of developing myocardial infarction, mainly without ST segment elevation, by 1.45 times during the first 5 years. In general, every 20 mmHg increase in systolic blood pressure. over 140 mm Hg. associated with a 32% increase in the incidence of major cardiovascular events. The main goal of therapy for post-transplant hypertension is the prevention of cardiovascular complications and hypertensive damage to the renal allograft. The difficulty of therapy is associated with the associated multiple comorbidity, forced polypharmacy, and a certain pathogenetic stage, which requires a multidisciplinary approach.

About the authors

Vladimir P. Nosov

Privolzhsky Research Medical University

Author for correspondence.
Email: elenas-nn@mail.ru

Dr.Sci. (Med.), Professor at the Department of Hospital Therapy and Emergency Medicine named after. V.G. Vogralik, Privilzhsky Research Medical University

Russian Federation, Nizhny Novgorod

Lyubov Y. Koroleva

Privolzhsky Research Medical University

Email: elenas-nn@mail.ru

Dr.Sci. (Med.), Professor at the Department of Hospital Therapy and General Preparations named after. V.G. Vogralik, Privilzhsky Research Medical University

Russian Federation, Nizhny Novgorod

Elena N. Solovyanova

Privolzhsky Research Medical University

Email: elenas-nn@mail.ru

Cand. Sci. (Med.), Associate Professor at the Department of Hospital Therapy and Emergency Medicine named after. V.G. Vogralik, Privilzhsky Research Medical University

Russian Federation, Nizhny Novgorod

References

  1. O’Connell P.J., Brown M., Chan T.M., et al. The role of kidney transplantation as a component of integrated care for chronic kidney disease. Kidney Int. Suppl. 2020;10(1):e78–85.
  2. Rangaswami J., Mathew R.O., Parasuraman R., et al. Cardiovascular disease in the kidney transplant recipient: epidemiology, diagnosis and management strategies. Nephrol. Dial. Transplant. 2019;34:760–73.
  3. Global Observatory on Donation and Transplantation. Organ Donation and Transplantation Activities. Available at: http://www.transplant-observatory.org/data-charts-and-tables/chart. Accessed 10 July, 2023.
  4. Anastasopoulos N.A., Dounousi E., Papachristou E., et al. Cardiovascular disease: Risk factors and applicability of a risk model in a Greek cohort of renal transplant recipients. World J. Transplant. 2017;7(1):49–56.
  5. Aziz F., Clark D., Garg N., et al. Hypertension guidelines: How do they apply to kidney transplant recipients. Transplant. Rev. (Orlando). 2018;32(4):225–33.
  6. Awan A.A., Niu J., Pan J.S., et al. Trends in the causes of death among kidney transplant recipients in the United States (1996-2014). Am. J. Nephrol. 2018;48(6):472–81.
  7. Ying T., Shi B., Kelly P..J, et al. Death after kidney transplantation: an analysis by era and time post-transplant. J. Am. Soc. Nephrol. 2020;31:2887–99.
  8. Tantisattamo E., Molnar M.Z., Ho B.T., et al. Approach and management of hypertension after kidney transplantation. Front. Med. (Lausanne) 2020;7:229.
  9. Malek-Hosseini S.A., Ghahramani N., Behzadi S., et al. Incidence of posttransplant hypertension among renal allograft recipients. Transplant. Proc. 1998;30(3):775–76.
  10. Halimi J.M., Ortiz A., Sarafidis P.A., et al. Hypertension in kidney transplantation: a consensus statement of the 'hypertension and the kidney' working group of the European Society of Hypertension. J. Hypertens. 2021;39:1513–21.
  11. Lu Y., Golshayan D., Marques-Vidal P., et al. Prevalence of hypertension and poorly controlled hypertension 6 and 12 month after solid organ transplantation in the Swiss Transplant Cohort Study. J. Hypertens. 2015;33:e229–30.
  12. Vetromile F., Pernin V., Szwarc I., et al. Prevalence and risk factors of noncontrolled and resistant arterial hypertension in renal transplant recipients. Transplantation. 2015;99(5):1016–22.
  13. Arias-Rodríguez M., Fernández-Fresnedo G., Campistol J.M., et al., RETENAL Group (Control of Resistant Hypertension in Renal Transplant. Prevalence, Significance). Prevalence and clinical characteristics of renal transplant patients with true resistant hypertension. J. Hypertens. 2015;33(5):1074–81.
  14. Glicklich D., Lamba R., Pawar R. Hypertension in the kidney transplant recipient: overview of pathogenesis, clinical assessment, and treatment. Cardiol. Rev. 2017;25(3):102–9.
  15. Didier R., Yao H., Legendre M., et al. Myocardial infarction after kidney transplantation: a risk and specific profile analysis from a Nationwide French Medical Information Database. J. Clin. Med. 2020;9(10):3356.
  16. Carpenter M.A., John A., Weir M.R., et al. BP, cardiovascular disease, and death in the Folic Acid for Vascular Outcome Reduction in Transplantation trial. J. Am. Soc. Nephrol. 2014;25(7):1554–62.
  17. Opelz G., Wujciak T., Ritz E. Association of chronic kidney graft failure with recipient blood pressure. Collaborative Transplant Study. Kidney Int. 1998;53(1):217–22.
  18. Opelz G., Dohler B. Collaborative Transplant Study. Improved long-term outcomes after renal transplantation associated with blood pressure control. Am. J. Transplant. 2005;5(11):2725–31.
  19. KDIGO clinical practice guideline for the care of kidney transplant recipients. Kidney Disease: Improving Global Outcomes (KDIGO) Transplant Work Group. Am. J. Transplant. 2009;9(Suppl. 3):S1–155.
  20. Cheung A.K., Chang T.I., Cushman W.C., et al. KDIGO 2021 clinical practice guideline for the management of blood pressure in chronic kidney disease. Kidney Int. 2021;99(3):S1–87.
  21. Williams B., Mancia G., Spiering W., et al. 2018 ESC/ ESH Guidelines for the management of arterial hypertension. Eur. Heart J. 2018;39(33):3021–104.
  22. Mancia G., Kreutz R., Brunström M., et al. 2023 ESH Guidelines for the management of arterial hypertension. The Task Force for the management of arterial hypertension of the European Society of Hypertension Endorsed by the European Renal Association (ERA) and the International Society of Hypertension (ISH). J. Hypertens. 2023;41:1–199.
  23. Whelton P.K., Carey R.M., Aronow W.S., et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: Executive summary: A report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines. Hypertension. 2018;71(6):e13–115.
  24. Nerenberg K.A., Zarnke K.B., Leung A.A., et al. Hypertension Canada’s 2018 guidelines for diagnosis, risk assessment, prevention, and treatment of hypertension in adults and children. Can. J. Cardiol. 2018;34(5):506–25.
  25. Кобалава Ж.Д., Конради А.О., Недогода С.В. от имени экспертов. Артериальная гипертензия у взрослых. Клинические рекомендации 2020. РКЖ. 2020;25(3):149–218. Чазова И.Е., Жернакова Ю.В. От имени экспертов. Клинические рекомендации. Диагностика и лечение артериальной гипертонии. Системные гипертензии. 2019;16(1):6–31.
  26. Malhotra R., Katz R., Weiner D.E., et al. Blood pressure, chronic kidney disease progression, and kidney allograft failure in kidney transplant recipients: A secondary analysis of the FAVORIT trial. Am. J. Hypertens. 2019;32(9): 816–23.
  27. Pagonas N., Bauer F., Seibert F.S., et al. Intensive blood pressure control is associated with improved patient and graft survival after renal transplantation. Sci. Rep. 2019;9:10507.
  28. Kuningas K., Driscoll J., Mair R., et al. Comparing glycaemic benefits of active versus passive lifestyle intervention in kidney allograft recipients: a randomized controlled trial. Transplant. 2020;104:1491–99.
  29. Lentine K.L., Anyaegbu E., Gleisner A., et al. Understanding medical care of transplant recipients through integrated registry and pharmacy claims data. Am. J. Nephrol. 2013;38(5):420–29.
  30. Koraishy F.M., Yamout H., Naik A.S., et al. Impacts of center and clinical factors in antihypertensive medication use after kidney transplantation. Clin. Transplant. 2020;34(3):e13803.
  31. Kuźmiuk-Glembin I., Adrych D., Tylicki L., et al. Treatment of hypertension in renal transplant recipients in four independent cross-sectional analyses. Kidney Blood Press. Res. 2018;43(1):45–54.
  32. Jehn U., Schütte-Nütgen K., Strauss M., et al. Antihypertensive treatment in kidney transplant recipients – A current single center experience. J. Clin. Med. 2020;9(12):3969.
  33. Cross N.B., Webster A.C., Masson P., et al. Antihypertensive treatment for kidney transplant recipients: systematic review and meta-analysis of randomized controlled trials. Transplant. 2009;88(1):7–18.
  34. Loutradis C., Sarafidis P., Marinaki S., et al. Role of hypertension in kidney transplant recipients. J. Hum. Hypertens. 2021;35(11):958–69.
  35. Pisano A., Bolignano D., Mallamaci F., et al. Comparative effectiveness of different antihypertensive agents in kidney transplantation: A systematic review and meta-analysis. Nephrol. Dial. Transpl. 2020;35(5):878–87.
  36. Duni A., Pavlakou P., Koutlas V., et al. Arterial hypertension in renal transplantation: Clinical implications, pathogenesis and current management strategies. Hell. J. Atheroscler. 2018;9:121–27.
  37. Philipp T., Martinez F., Geiger H., et al. Candesartan improves blood pressure control and reduces proteinuria in renal transplant recipients: results from SECRET. Nephrol. Dial. Transplant. 2010;25(3):967–76.
  38. Knoll G.A., Fergusson D., Chassé M., et al. Ramipril versus placebo in kidney transplant patients with proteinuria: a multicentre, double-blind, randomised controlled trial. Lancet. Diab. Endocrinol. 2016;4(4):318–26.
  39. brahim H.N., Jackson S., Connaire J., et al. Angiotensin II blockade in kidney transplant recipients. J. Am. Soc. Nephrol. 2013;24(2):320–27. Hiremath S., Fergusson D.A., Fergusson N., et al. Renin-angiotensin system blockade and long-term clinical outcomes in kidney transplant recipients: A meta-analysis of randomized controlled trials. Am. J. Kidney Dis. 2017;69(1):78–86.
  40. Cheungpasitporn W., Thongprayoon C., Mao M.A., et al. The effect of renin-angiotensin system inhibitors on kidney allograft survival: A systematic review and meta-analysis. North Am. J. Med. Sci. 2016;8(7):291–96.
  41. Jiang Y.M., Song T.R., Qiu Y., et al. Effect of renin-angiotensin system inhibitors on survival in kidney transplant recipients: a systematic review and meta-analysis. Kaohsiung J. Med. Sci. 2018;34(1):1–13.
  42. Shin J.I., Palta M., Djamali A., et al. The association between renin-angiotensin system blockade and long-term outcomes in renal transplant recipients: The Wisconsin Allograft Recipient Database (WisARD). Transplant. 2016;100(7):1541–49.
  43. Moes A.D., Hesselink D.A., van den Meiracker A.H., et al. Chlorthalidone versus amlodipine for hypertension in kidney transplant recipients treated with tacrolimus: a randomized crossover trial. Am. J. Kidney Dis. 2017;69(6): 796–804.
  44. de Sousa M.V., Guida J.P., do Valle C.F., et al. Spironolactone in post-transplant proteinuria: a safe alternative therapy. Transplant. Proc. 2017;49(4):813–16.
  45. Bertocchio J.P., Barbe C., Lavaud S., et al. Safety of eplerenone for kidney-transplant recipients with impaired renal function and receiving cyclosporine A. PLoS ONE. 2016;11:e0153635. doi: 10.1371/journal.pone.0153635.
  46. Tong A., Budde K., Gill J., et al. Standardized outcomes in nephrology-transplantation: a global initiative to develop a core outcome set for trials in kidney transplantation. Transplant. Direct. 2016;2(6):e79.
  47. Woźniak I., Kolonko A., Chudek J., et al. Influence of polypharmacy on the quality of life in stable kidney transplant recipients. Transplant. Proc. 2018;50(6):1896–99.
  48. Nevins T.E., Nickerson P.W., Dew M.A. Understanding medication nonadherence after kidney transplant. J. Am. Soc. Nephrol. 2017;28(8):2290–301.
  49. Obremska M., Boratyńska M., Zyśko D., et al. Beneficial effect of bilateral native nephrectomy as complete denervation on left ventricular mass and function in renal transplant recipients. Pol. Arch. Med. Wewn. 2016;126(1–2):58–67.
  50. Schneider S., Promny D., Sinnecker D., et al. Impact of sympathetic renal denervation: a randomized study in patients after renal transplantation (ISAR-denerve). Nephrol. Dial. Transplant. 2015;30(11):1928–36.
  51. Sandal S., Bansal P., Cantarovich M. The evidence and rationale for the perioperative use of loop diuretics during kidney transplantation: А comprehensive review. Transplant. Rev. (Orlando). 2018;32(2):92–101.
  52. Udomkarnjananun S., Townamchai N., Iampenkhae K., et al. Furosemide stress test as a predicting biomarker for delayed graft function in kidney transplantation. Nephron. 2019;141(4):236–48.
  53. Сasper J., Schmitz J., Bräsen J.H., et al. Renal transplant recipients receiving loop diuretic therapy have increased urinary tract infection rate and altered medullary macrophage polarization marker expression. Kidney Int. 2018;94(5):993–1001.

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2. Table 2. Effect of antihypertensive drugs on primary endpoints in post-transplant hypertension

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