Blood pressure management and long-term outcomes in kidney transplantation: a holistic view over a 35-year period.

Autor: Wangueu LT; Hôpital Bretonneau, Néphrologie-Immunologie Clinique, CHU Tours, Tours, France., de Fréminville JB; Hôpital Bretonneau, Néphrologie-Immunologie Clinique, CHU Tours, Tours, France., Gatault P; Hôpital Bretonneau, Néphrologie-Immunologie Clinique, CHU Tours, Tours, France.; EA4245, University of Tours, Tours, France., Buchler M; Hôpital Bretonneau, Néphrologie-Immunologie Clinique, CHU Tours, Tours, France.; EA4245, University of Tours, Tours, France., Longuet H; Hôpital Bretonneau, Néphrologie-Immunologie Clinique, CHU Tours, Tours, France., Bejan-Angoulvant T; Centre Hospitalier Universitaire Et Faculté de Médecine, Pharmacologie Médicale, EA4245, Université de Tours, Tours, France., Sautenet B; Hôpital Bretonneau, Néphrologie-Immunologie Clinique, CHU Tours, Tours, France.; INI-CRCT, vandoeuvre-Lès-Nancy, France.; INSERM U1246 SPHERE, Université de Tours-Université de Nantes, Tours, France., Halimi JM; Hôpital Bretonneau, Néphrologie-Immunologie Clinique, CHU Tours, Tours, France. halimi@med.univ-tours.fr.; EA4245, University of Tours, Tours, France. halimi@med.univ-tours.fr.; INI-CRCT, vandoeuvre-Lès-Nancy, France. halimi@med.univ-tours.fr.; Service de Néphrologie, Hôpital Bretonneau, CHU Tours, 2 Boulevard Tonnellé, 37000, Tours, France. halimi@med.univ-tours.fr.
Jazyk: angličtina
Zdroj: Journal of nephrology [J Nephrol] 2023 Sep; Vol. 36 (7), pp. 1931-1943. Date of Electronic Publication: 2023 Aug 07.
DOI: 10.1007/s40620-023-01706-9
Abstrakt: Introduction: Hypertension is a burden for most kidney transplant recipients. Whether respect of hypertension guidelines results in better outcomes is unknown.
Methods: In this multicenter study, office blood pressure at 12 months following transplantation (i.e., after > 20 outpatient visits), and survival were assessed over 35 years among 2004 consecutive kidney transplant recipients who received a first kidney graft from 1985 to 2019 (follow-up: 26,232 patient-years).
Results: Antihypertensive medications were used in 1763/2004 (88.0%) patients. Renin-angiotensin-system blockers were used in 35.6% (47.1% when proteinuria was > 0.5 g/day) and calcium-channel blockers were used in 6.0% of patients. Combined treatment including renin-angiotensin-system-blockers, calcium-channel blockers and diuretics was used in 15.4% of patients receiving ≥ 3 antihypertensive drugs. Blood pressure was controlled in 8.3%, 18.8% and 43.1%, respectively, depending on definition (BP < 120/80, < 130/80, < 140/90 mmHg, respectively) and has not improved since the year 2001. Two-thirds of patients with uncontrolled blood pressure received < 3 antihypertensive classes. Low sodium intake < 2 g/day (vs ≥ 2) was not associated with better blood pressure control. Uncontrolled blood pressure was associated with lower patient survival (in multivariable analyses) and graft survival (in univariate analyses) vs controlled hypertension or normotension. Low sodium intake and major antihypertensive classes had no influence on patient and graft survival.
Conclusions: Pharmacological recommendations and sodium intake reduction are poorly respected, but even when respected, do not result in better blood pressure control, or patient or graft survival. Uncontrolled blood pressure, not the use of specific antihypertensive classes, is associated with reduced patient, and to a lesser extent, reduced graft survival, even using the 120/80 mmHg cut-off.
(© 2023. The Author(s) under exclusive licence to Italian Society of Nephrology.)
Databáze: MEDLINE
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