Blood Pressure Control in Orthotopic Heart Transplant and Kidney Allograft Recipients Is Far From Satisfactory

Hypertension is widely accepted as a risk factor for coronary artery disease, heart failure, stroke, or chronic kidney disease. According to ESH/ESC and JNC guidelines, the target blood pressure should be low 140/90 mm Hg in the general population, and 130/80 mm Hg among patients with chronic kidney disease or diabetes. The aim of this study was to assess the prevalence of achieved target blood pressure among 164 prevalent heart transplant recipients as well as 172 prevalent, kidney transplant, 100 hemodialyzed, and 50 peritoneally dialyzed patients on renal replacement therapy. We assessed kidney function in transplanted patients using the simplified MDRD formula. In the heart transplant (OHT) population, 10% had diabetes and 65% chronic kidney disease; in the kidney transplant population 18% had diabetes. Hypertension was treated in 70% of OHT, 92% of kidney 90% of hemodialyzed and 70% of peritoneally dialyzed patients. In the OHT population, only 43% of subjects achieved the target blood pressure, while 42% among kidney transplant, 50% of hemodialzyed, and only 20% of peritoneally dialyzed patients did so. Hypertensive OHT as well as kidney transplant subjects were older, displayed higher serum creatinine values and lower estimated glomerular filtration rates. Hypertensive patients after OHT were treated with ACE inhibitors (50%), calcium channel blockers (55%), diuretics (34%), β-blockers (34%), and/or spironolactone (5%). Among hypertensive kidney allograft recipients, the most commonly used drugs were calcium channel blockers (80%), β-blockers (60%), diuretics (55%) ACE inhibitors (40%), and α-blockers (12%). The kidney transplant population required three and more hypotensives in 63% of cases. Despite polytherapy optimal blood pressure control was not achieved in the majority of patients. OHT and kidney graft recipients displayed a high prevalence of hypertension, which should be treated adequately. More efforts must be dedicated to optimize blood pressure control, particularly in the presence of other comorbidities.