The following is a summary of “Blood pressure management and long-term outcomes in kidney transplantation: a holistic view over a 35-year period,” published in the August 2023 issue of Nephrology by Wangueu et al.
Hypertension is a concern for kidney transplant recipients, and it’s unclear if following hypertension guidelines improves results. Researchers performed a retrospective study in a 35-year study spanning from 1985 to 2019; in 2004, kidney transplant recipients with their first grafts were examined. After >20 outpatient visits, office blood pressure at 12 months post-transplantation was evaluated. Survival was also assessed, with a follow-up totaling 26,232 patient-years.
The results showed Antihypertensive medications in 88.0% of patients (1763/2004). Renin-angiotensin-system (RAS) blockers in 35.6% (47.1% with proteinuria >0.5 g/day). Calcium-channel blockers: 6.0%. Combo therapy (RAS blockers, calcium-channel blockers, diuretics) in 15.4% in ≥3 meds patients. BP control was associated with 8.3% (<120/80 mmHg), 18.8% (<130/80 mmHg), and 43.1% (<140/90 mmHg). No improvement since 2001. Uncontrolled BP was with >2/3 patients with <3 antihypertensive classes. Low sodium intake <2 g/day (vs ≥ 2) was not associated with better blood pressure control. Uncontrolled BP linked to lower patient survival (multivariable) and graft survival (univariate) vs controlled/normotension. Low sodium and major antihypertensive classes didn’t impact patient and graft survival.
They concluded poor medication adherence leads to lower patient and graft survival, even at 120/80 mmHg cutoff.