Fernández-Fresnedo G, Gago-Fraile M, Gómez-Alamillo C, Sanz de Castro S, Arias-Rodriguez M
Nephrology Service, Hospital Universitario Marqués de Valdecilla, Instituto de Formación e Investigación Marqués de Valdecilla, Sanatander, Spain.
Transplant Proc. 2010 Oct;42(8):2908-9. doi: 10.1016/j.transproceed.2010.07.042.
Hypertension is common after renal transplantation, affecting as many as 80% of recipients. It is generally accepted that hypertension is associated with poor graft survival and reduced life expectancy because of increased cardiovascular risk factors. The prevalence of refractory hypertension in renal transplant recipients is unknown, and could be associated with a poor prognosis.
To investigate the effects of refractory hypertension on cardiovascular disease (CVD) after renal transplantation in 486 patients with grafts functioning for longer than 1 year.
Patients were classified into 2 groups: (1) 57 with refractory hypertension, that is, systolic blood pressure 130 mm Hg or greater or diastolic blood pressure 80 mm Hg or greater, and receiving treatment with at least 3 drugs, one of which was a diuretic; and (2) the remaining 429 patients. Patient and graft survival, and posttransplantation CVD were analyzed.
Refractory hypertension was associated with male sex (82.5% vs 66.5% [P<.01]), poor renal function (mean [SD] serum creatinine concentration 2.2 [1.2] mg/dL vs 1.6 [0.6] mg/dL; Modification of Diet in Renal Disease score 39.2 [20.0] mL/min/1.73 m2 vs 49.2 [18.0] mL/min/1.73 m2 [P=.000]; and steroid therapy (94.7% vs 79.0% [P=.001]). In the group with refractory hypertension, 5-year patient and graft survival rates were lower, and the incidence of posttransplantation CVD was greater (relative risk, 1.7; 95% confidence interval, 1.05-2.18; P=.03).
Refractory hypertension is an independent risk factor for increased cardiovascular morbidity and mortality in renal transplant recipients.
肾移植后高血压很常见，多达80%的受者会受到影响。人们普遍认为，由于心血管危险因素增加，高血压与移植肾存活率低和预期寿命缩短有关。肾移植受者中难治性高血压的患病率尚不清楚，且可能与预后不良有关。
调查486例移植肾功能正常超过1年的患者中难治性高血压对肾移植后心血管疾病（CVD）的影响。
患者分为两组：（1）57例难治性高血压患者，即收缩压≥130 mmHg或舒张压≥80 mmHg，且接受至少3种药物治疗，其中一种为利尿剂；（2）其余429例患者。分析患者和移植肾存活率以及移植后心血管疾病情况。
难治性高血压与男性（82.5%对66.5%[P<0.01]）、肾功能差（平均[标准差]血清肌酐浓度2.2[1.2]mg/dL对1.6[0.6]mg/dL；肾病饮食改良评分39.2[20.0]mL/min/1.73 m²对49.2[18.0]mL/min/1.73 m²[P = 0.000]）以及类固醇治疗（94.7%对79.0%[P = 0.001]）有关。在难治性高血压组中，5年患者和移植肾存活率较低，移植后心血管疾病的发生率较高（相对风险，1.7；95%置信区间，1.05 - 2.18；P = 0.03）。
难治性高血压是肾移植受者心血管发病率和死亡率增加的独立危险因素。
