Adrych D, Kuźmiuk-Glembin I, Tylicki L, Heleniak Z, Garnier H, Wiśniewski J, Rutkowski P, Rutkowski B, Dębska-Ślizień A
Department of Nephrology, Transplantology, and Internal Medicine, Medical University of Gdansk, Gdansk, Poland.
Unit of Clinical Pharmacology, Department of Nephrology, Transplantology, and Internal Medicine, Medical University of Gdansk, Gdansk, Poland.
Transplant Proc. 2018 Jan-Feb;50(1):155-159. doi: 10.1016/j.transproceed.2017.11.023.
Hypertension is a very common complication in renal transplant recipients (RTRs). It has been identified as a potent cardiovascular risk factor associated with impaired patient and graft survival.
A longitudinal retrospective analysis was performed to evaluate adherence to recommended blood pressure (BP) targets and to estimate the tendency in the management of hypertension from 2001 to 2015. A total of 96 RTRs (55 male, 41 female; overall mean age (2001), 41.66 ± 11.08 years; mean serum creatinine level, 1.45 ± 0.3 mg/dL; 41.2 ± 34.9 months after kidney transplantation) with diagnoses of hypertension and monitored continuously in the unit from 2001 to 2015 were included in the study.
The average diastolic BP decreased (P < .01) and the average systolic BP did not change in this period. The target values of BP (ie, <140/90 mm Hg) were accomplished by 45.8% (2001) and 53.1% (2015) of patients. When the target BP was corrected by age (<150/90 mm Hg for people >65 years old) the adherence improved to 57.29% in 2015. The average number of antihypertensive agents used per patient increased significantly (P < .001): 2.03 ± 1.0 (2001) versus 2.69 ± 1.26 (2015). The most commonly used antihypertensive agents were beta-blockers: 69% and 74% in 2001 and 2015, respectively. There was a significant increase in the percentage of RTRs treated with the use of alpha-blockers (P < .01), angiotensin-converting enzyme inhibitors (P < .001), and angiotensin II receptor blockers (P < .05).
The study showed modest improvement of the hypertension control rate from 2001 to 2015 in RTRs. Greater efforts are needed to implement the guidelines, which would further improve patient and graft outcomes.
高血压是肾移植受者（RTRs）中非常常见的并发症。它已被确定为一种与患者和移植物生存受损相关的强大心血管危险因素。
进行了一项纵向回顾性分析，以评估对推荐血压（BP）目标的依从性，并估计2001年至2015年高血压管理的趋势。共有96例诊断为高血压且在2001年至2015年期间在该科室持续监测的肾移植受者（55例男性，41例女性；总体平均年龄（2001年），41.66±11.08岁；平均血清肌酐水平，1.45±0.3mg/dL；肾移植后41.2±34.9个月）纳入研究。
在此期间，平均舒张压下降（P <.01），平均收缩压未改变。血压目标值（即<140/90mmHg）在2001年和2015年分别由45.8%和53.1%的患者实现。当根据年龄校正血压目标（65岁以上人群<150/90mmHg）时，2015年的依从性提高到57.29%。每位患者使用的抗高血压药物平均数量显著增加（P <.001）：2001年为2.03±1.0，2015年为2.69±1.26。最常用的抗高血压药物是β受体阻滞剂：2001年和2015年分别为69%和74%。使用α受体阻滞剂（P <.01）、血管紧张素转换酶抑制剂（P <.001）和血管紧张素II受体阻滞剂（P <.05）治疗的肾移植受者百分比显著增加。
该研究表明，2001年至2015年肾移植受者的高血压控制率有适度提高。需要做出更大努力来实施指南，这将进一步改善患者和移植物的结局。
