Blood Pressure Treatment in Kidney Transplant Recipients—Can We Improve?. Issue 4 (April 2021)

• Record Type: Journal Article
• Authors: Onsøien, Mari O.; Midtvedt, Karsten; Reisæter, Anna V.; Aasarød, Knut; Waldum-Grevbo, Bård; Vikse, Bjørn Egil; Eriksen, Bjørn Odvar; Åsberg, Anders
• Is Part Of: Transplantation direct. Volume 7:Issue 4(2021)
• Publication Date: 2021-04
• Subjects: Transplantation of organs, tissues, etc -- Periodicals; Transplantation -- Periodicals; 362.19795
• DOI: 10.1097/TXD.0000000000001142
• Languages: English
• ISSNs: 2373-8731

Abstract

Abstract : Background: 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. Methods: 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). Results: 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 ( P < 0.05) compared with patients with controlled hypertension ("on-target" group). Valid survey answers were available for 84% of the "above-target" group (Survresp ) with no significant demographic differences versus nonresponders (Survnonresp ). Among Survresp, 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 Survresp . 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 ( P < 0.05). Automatic attended BP measurement was utilized by 51%. Conclusions: In KTx recipients, a higher BP target achievement seems possible, potentially in the range of 75%-80%.