Blood Pressure Control According to the Prevalence of Diabetes in Renal Transplant Recipients

Abstract

Background: ension is also one of the most frequent complications of renal transplantation (Tx) and about 70-90% of this population have either a high blood pressure (BP) or require antihypertensive therapy. Diabetes mellitus is also a common finding in kidney transplant recipients. Aim: The aim of the study was to assess the blood pressure control in kidney transplant recipients according to the prevalence of diabetes. The retrospective analysis included 172 (mean age 50 years, 51% male,) renal transplant recipients. Results: The mean age of the studied group was 50 years and 51% (N=88) of them were men. Hypertension was present in 79% patients. Mean BP was 130/80 mmHg. The studied cohort was divided according to the presence of diabetes into two groups: group I - patients with diabetes (N=14, 8%) and group 2 - patients without diabetes (N=158). Patients from group I was significantly older than those from group II (p< 0,05) and their time after renal transplantation was longer (98,83 vs 67,33 months, p< 0,05). There was no difference between patients with and without diabetes in the presence of hypertension, the mean blood pressure value, the percentage of abnormal (> 140/90 mmHg) BP rate, glomerular filtration rate and laboratory tests, including serum cyclosporine and tacrolimus level. The analysis of the kind of immunosuppressive therapy revealed the less use of steroids in the group with diabetes. The characteristic of the studied group is demonstrated in table 1. In the whole cohort the following hypotensive drugs were used: beta-blockers-37%, calcium channel blockers-27%, angiotensin converting enzyme inhibitors (ACEi)-23% and diuretics-12%. The main used hypotensive drug in patients without diabetes was beta-blocker-28%, followed by calcium channel blockers-21% and ACEi-21%, then diuretics-14%. In patients with diabetes used beta-blockers and ACEI were used with the same frequency-37%, followed by calcium channel blockers-28% and diuretics-12%. The mean number of used hypotensive drug was one in all of patients regardless of diabetes. The whole studied cohort of renal transplant recipients was also analyzed according to the kind of immunosuppressive therapy. Calcineurin inhibitors were taken by 97% (N=167) of patients. More of them were hypertensive comparing to not-users of CNI (98% (N=130) vs 92% (N=36), p=0,04) and their BP rate was higher (130/80 vs 120/70 mmHg, p< 0,05). They had more often diabetes (8% (N=14) vs 0%) and total cholesterol concentration (Table 2). Steroids were used by 64% (N=111) of renal transplant recipients. Patients on steroids therapy has shorter time after Tx comparing to patients who did not take steroids. Patients administered with steroides users had also lower eGFR. The mean fasting glucose was lower and the prevalence of diabetes was less in the group without using steroids. Conclusions: More aggressive antihypertensive treatment using combined drugs, including RAS blocker, would provide to adequate BP control in study cohort after renal Tx, which is with high cardiovascular risk.