Nephrology Service, Universitary Hospital Marqués de Valdecilla, 39008 Santander, Spain.
Nephrol Dial Transplant. 2012 Dec;27 Suppl 4:iv36-8. doi: 10.1093/ndt/gfs481.
Hypertension is a prevalent complication that occurs in 80-85% of all kidney transplant recipients. The pathogenesis of post-transplant hypertension is multifactorial and includes pre-transplant hypertension, donor hypertension, renin secretion from the native kidney, graft dysfunction, recurrent disease and immunosuppressive treatment. Hypertension negatively affects transplant and patient survival outcomes; cardiovascular disease (CVD) is the leading cause of morbidity and mortality in patients with chronic renal disease and after successful renal transplantation. Hypertension is a well-known risk factor for CVD and it is frequently associated with other CVD risk factors. Despite increased awareness of the adverse effects of hypertension in both graft and patient survival, long-term studies have shown that arterial hypertension in the transplant population has not been adequately controlled. Resistant hypertension (RH) is defined as office blood pressure (oBP) that remains above goal (oBP ≥ 140/90 or 130/80 mmHg) in patients with diabetes or chronic kidney disease despite the concurrent use of three antihypertensive agents, at full doses, one of them being a diuretic. Despite studies in the general population and the high prevalence of hypertension in renal transplant patients, data about RH are very scarce and the prevalence of RH in renal transplant patients is unknown and could be associated with a worse prognosis.
高血压是一种常见的并发症，发生在所有肾移植受者的 80-85%中。移植后高血压的发病机制是多因素的，包括移植前高血压、供体高血压、来自原生肾脏的肾素分泌、移植物功能障碍、复发性疾病和免疫抑制治疗。高血压对移植和患者生存结果产生负面影响；心血管疾病（CVD）是慢性肾脏病患者和成功肾移植后的主要发病率和死亡率原因。高血压是 CVD 的已知危险因素，并且经常与其他 CVD 危险因素相关。尽管人们越来越意识到高血压对移植物和患者生存的不良影响，但长期研究表明，移植人群中的动脉高血压并未得到充分控制。耐药性高血压（RH）定义为在同时使用三种降压药物（其中一种为利尿剂）、全剂量治疗的情况下，糖尿病或慢性肾脏病患者的诊室血压（oBP）仍高于目标值（oBP≥140/90 或 130/80mmHg）。尽管在一般人群中进行了研究，并且肾移植患者中高血压的患病率很高，但关于 RH 的数据非常有限，肾移植患者中 RH 的患病率尚不清楚，并且可能与预后更差相关。
