European best practice guidelines for renal transplantation. Section IV: Long-term management of the transplant recipient. IV.5.2. Cardiovascular risks. Arterial hypertension.

A. Arterial hypertension is often present after renal transplantation and is of multifactorial origin. Pre-transplant arterial hypertension, chronic allograft nephropathy and immunosuppressive therapy are the most frequent causes of post-transplant arterial hypertension. Careful monitoring and treatment of high blood pressure are recommended following transplantation. B. Post-transplant arterial hypertension is associated with an increased incidence of cardiovascular disease in renal transplant patients and is an independent risk factor for graft failure. Therefore, blood pressure control (<130/85 mmHg for renal transplant recipients without proteinuria, and <125/75 mmHg for proteinuric patients) is mandatory in these patients. General measures and pharmacological intervention are necessary in many cases. In proteinuric patients, anti-hypertensive and anti-proteinuric agents could be used, and stricter blood pressure control is recommended. C. In patients with uncontrolled arterial hypertension and/or renal function deterioration, underlying causes should be excluded, especially transplant renal artery stenosis.