Dobrowolski L C, Bemelman F J, van Donselaar-van der Pant K A M I, Hoitsma A J, ten Berge I J M, Krediet C T P
Department of Internal Medicine, Division of Nephrology - Renal Transplant Unit, Academic Medical Centre, Amsterdam, the Netherlands.
Neth J Med. 2014 Jun;72(5):258-63.
Hypertension in kidney transplant recipients jeopardises graft and patient survival. Guidelines suggest blood pressure targets of ≤130/80 mmHg and sodium intake <90 mmol/day.
Since the efficacy of antihypertensive treatment among kidney transplant recipients is unknown, we analysed data on office-based blood pressure and use of antihypertensive drugs from the Netherlands Organ Transplant Registry on 5415 kidney transplant recipients. Additionally, we studied dosages, prevalence of treatment-resistant hypertension and 24-hour sodium excretion in 534 kidney transplant recipients from our centre to explore possibilities for therapy optimisation.
In patients registered in the Netherlands Organ Transplant Registry, median blood pressure was 134/80 mmHg (interquartile range 122-145/70-85). In 77.2%, the blood pressure was ≥130/80 mmHg; of these patients 10.4% had no registered use, 30.0% used one and 25.9% used ≥3 classes of antihypertensive agents. Parameters from our centre were comparable: 78.7% had a median blood pressure of ≥130/80 mmHg of whom 14.5% had no registered use of antihypertensives and 26.4% used ≥3 classes. Sub-maximal dosages were prescribed in 74.0% of the kidney transplant recipients with a blood pressure of ≥130/80 mmHg while using at least one antihypertensive agent. Treatment-resistant hypertension was present in 7.7%. Median 24-hour sodium excretion was 147 mmol/day (interquartile range 109-195).
This study suggests that therapeutic optimisation of antihypertensive treatment in kidney transplant recipients is, in theory, frequently possible by intensifying pharmacological treatment and by providing more advice on dietary sodium restrictions.
肾移植受者的高血压会危及移植物和患者的生存。指南建议血压目标≤130/80 mmHg，钠摄入量<90 mmol/天。
由于肾移植受者中降压治疗的疗效未知，我们分析了荷兰器官移植登记处5415例肾移植受者基于诊室测量的血压数据和降压药物使用情况。此外，我们研究了来自我们中心的534例肾移植受者的药物剂量、难治性高血压患病率和24小时钠排泄情况，以探索优化治疗的可能性。
在荷兰器官移植登记处登记的患者中，血压中位数为134/80 mmHg（四分位间距122 - 145/70 - 85）。77.2%的患者血压≥130/80 mmHg；在这些患者中，10.4%未登记使用降压药，30.0%使用一种，25.9%使用≥3类降压药。我们中心的参数与之相似：78.7%的患者血压中位数≥130/80 mmHg，其中14.5%未登记使用降压药，26.4%使用≥3类降压药。在血压≥130/80 mmHg且至少使用一种降压药的肾移植受者中，74.0%的患者使用的是次最大剂量。难治性高血压的患病率为7.7%。24小时钠排泄中位数为147 mmol/天（四分位间距109 - 195）。
本研究表明，理论上，通过强化药物治疗和提供更多关于饮食钠限制的建议，肾移植受者的降压治疗优化通常是可行的。
