Kislikova M, Seras M, Monfa E, Rodrigo E, Fernandez-Fresnedo G, Ruiz J C, Arias M
Hospital Universitario Marques de Valdecilla, Santander, Spain.
Hospital Universitario Marques de Valdecilla, Santander, Spain.
Transplant Proc. 2015 Jan-Feb;47(1):76-7. doi: 10.1016/j.transproceed.2014.12.009.
High blood pressure (BP) affects up to 90% of kidney transplant recipients and is associated with lower patient and graft survival rates. Kidney Disease/Improving Global Outcomes (KDIGO) guidelines suggest maintaining BP at lower than 130/80 mm Hg. Multidrug therapy is usually required for the control of BP in this population. Our aim was to analyze the number of antihypertensive drugs used in our kidney transplantation population at 1 year after transplantation and their influence on graft and patient outcome. We included 411 deceased-donor kidney transplantation cases; data were obtained from a prospectively maintained institutional database. BP was measured at the outpatient clinic. Approximately 97 patients were not under antihypertensive therapy, whereas 130, 119, 52, and 13 received 1, 2, 3, or 4 antihypertensive drugs, respectively. The number of antihypertensive drugs was significantly related to lower patient survival rates independently of a previous diagnosis of hypertension and diabetes, recipient age and sex and renal function at 1-year. After multivariate linear regression analysis high body mass index, male gender of recipients, donor hypertension, previous acute rejection, and cyclosporine therapy were risk factors independently related to a higher number of antihypertensive drugs. To conclude, the number of antihypertensive drugs is an objective and easy-to-measure marker related to lower patient survival rates. Recipient body mass index, type of calcineurin inhibitor, and acute rejection are modifiable risk factors whose control can help to reduce the number of antihypertensive drugs needed to treat high BP in the kidney transplantation population.
高血压影响着高达90%的肾移植受者，并且与患者和移植物较低的存活率相关。肾脏病改善全球预后（KDIGO）指南建议将血压维持在低于130/80 mmHg。在这一人群中控制血压通常需要多药联合治疗。我们的目的是分析肾移植人群在移植后1年使用的抗高血压药物数量及其对移植物和患者预后的影响。我们纳入了411例尸体供肾移植病例；数据来自一个前瞻性维护的机构数据库。在门诊测量血压。大约97例患者未接受抗高血压治疗，而分别有130例、119例、52例和13例接受了1种、2种、3种或4种抗高血压药物治疗。抗高血压药物的数量与较低的患者存活率显著相关，独立于高血压和糖尿病的既往诊断、受者年龄和性别以及1年时的肾功能。经过多变量线性回归分析，高体重指数、受者男性性别、供体高血压、既往急性排斥反应和环孢素治疗是与抗高血压药物数量较多独立相关的危险因素。总之，抗高血压药物的数量是一个与较低患者存活率相关的客观且易于测量的指标。受者体重指数、钙调神经磷酸酶抑制剂类型和急性排斥反应是可改变的危险因素，控制这些因素有助于减少肾移植人群治疗高血压所需的抗高血压药物数量。
