Cyclosporine and posttransplant hypertension.

Prevalence studies suggest that hypertension is present in more than 50% of kidney transplant patients. It is more prevalent in pediatric patients, and cyclosporine has added to the rates in both children and adults. Hypertension is an important risk factor for cardiovascular disease, which remains the leading cause of death for recipients of renal transplants. Fortunately, posttransplant hypertension is commonly mild to moderate in nature (transplant artery stenosis hypertension being the exception) and can be treated medically. However, the removal of native kidneys and the correction of arterial stenosis are two surgical interventions that are more common in the transplant population than in the general population. In posttransplant hypertension that is primarily due to cyclosporine, one must balance the risks of reduced cyclosporine dosage against the risks of the hypertension. Both diuretic and calcium channel blocker therapy are believed to be useful in cyclosporine-induced hypertension. Other vasodilators also may be effective, although they may have undesired effects on RBF and glomerular filtration.