HYPERTENSION AFTER RENAL-TRANSPLANTATION

In 212 cyclosporine-treated renal transplant recipients with stable graft function at 1 year and with potential followup of 5 years the prevalence of arterial hypertension was 81.6% at 1 year and 81.2% at 5 years. The logistic regression analysis showed that the presence of hypertension before transplantation (P = 0.0001; odds ratio 3.5), a plasma creatinine level higher than 2 mg/dL at 1 year (P = 0.0001; odds ratio 3.8), and a maintenance therapy with corticosteroids (P = 0.008; odds ratio 3.3) were positively associated with hypertension at 1 year after transplantation. The mean number of graft failures between 1 and 5 years was significantly higher and the mean reciprocal of plasma creatinine was significantly worse at 1 and 5 years in patients with noncontrolled hypertension than in normotensive patients or in patients with hypertension well controlled by drugs. We also investigated the potential protective role of nifedipine. The episodes of acute tubular necrosis (four versus three), of acute rejections (28 versus 29), the mean arterial pressure at 1 year (105 ± 9 versus 104 ± 9 mm Hg) and 5 years. (105 ± 10 versus 108 ± 12 mm Hg), and the mean plasma creatinine level at 1 year (1.4 ± 0.4 versus 1.6 ± 0.4 mg/dL) and 5 years (1.8 ± 1 versus 1.9 ± 1 mg/dL) were similar in 52 patients who were given nifedipine for at least 4 years and 58 hypertensive patients who never took calcium channel blockers. To evaluate whether an early administration of nifedipine might have a protective role on the graft we separated patients who started nifedipine within 3 days (17 patients) from those who were given the drug 4 or more days after transplantation (35 patients). No case of acute tubular necrosis was seen in patients treated early, while four cases occurred in the group receiving nifedipine later. The number of rejections (nine versus 19), mean arterial pressure at 1 year (105 ± 8 versus 105 ± 9 mm Hg) and 5 years (105 ± 11 versus 104 ± 9 mm Hg), and the mean plasma creatinine level at 1 year (1.5 ± 0.5 versus 1.5 ± 0.4 mg/dL) and 5 years (1.9 ± 1.5 versus 1.9 ± 0.9 mg/dL) were similar in the two groups. © 1993, National Kidney Foundation, Inc.. All rights reserved.