Abstract
Hypertension is a common and serious complication after renal transplantation. It is an important risk factor for graft loss and morbidity and mortality of transplanted children. The etiology of posttransplant hypertension is multifactorial: native kidneys, immunosuppressive therapy, renal-graft artery stenosis, and chronic allograft nephropathy are the most common causes. Blood pressure (BP) in transplanted children should be measured not only by casual BP (CBP) measurement but also regularly by ambulatory BP monitoring (ABPM). The prevalence of posttransplant hypertension ranges between 60% and 90% depending on the method of BP measurement and definition. Left ventricular hypertrophy is a frequent type of end-organ damage in hypertensive children after transplantation (50–80%). All classes of antihypertensive drugs can be used in the treatment of posttransplant hypertension. Hypertension control in transplanted children is poor; only 20–50% of treated children reach normal BP. The reason for this poor control seems to be inadequate antihypertensive therapy, which can be improved by increasing the number of antihypertensive drugs. Improved hypertension control leads to improved long-term graft and patient survival in adults. In children, there is a great potential for antihypertensive treatment that could also result in improved graft and patient survival.
Highlights
Hypertension is a common and serious complication in adult as well as in pediatric patients after renal transplantation [1,2,3]
In our single-center, cross-sectional study we found no significant differences between normotensive and hypertensive children in graft function or presence of biopsy-proven chronic rejection
Hypertension is a frequent complication in children after renal transplantation, with a prevalence ranging from 60% to 90%
Summary
Hypertension is a common and serious complication in adult as well as in pediatric patients after renal transplantation [1,2,3]. CBP has its limitations, mainly in that it can neither distinguish between true and white-coat hypertension (i.e. increased CBP in the presence of physician or nurse but normal ambulatory BP) nor measure BP during nighttime and sleep It has been shown in several studies that ambulatory BP monitoring (ABPM) is a better method for evaluating BP than is CBP measurement in children after renal transplantation [12,13,14]. Some studies using ABPM defined hypertension using the 95th percentile for CBP [24, 25] and other studies only on the basis of antihypertensive drugs use without taking the current BP level into account [2, 3]. Using antihypertensive drugs as the only criterion for defining hypertension without knowing the current BP level would lead to
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