Chatzikyrkou Christos, Schmieder Roland E, Schiffer Mario
Medical Faculty, Otto-von Guericke University Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany.
Department of Internal Medicine 4-Nephrology, University Hospital of Erlangen, Erlangen, Germany.
Curr Hypertens Rep. 2021 May 7;23(5):25. doi: 10.1007/s11906-021-01151-8.
To incorporate novel findings on pathophysiology and treatment of posttransplant hypertension.
(1) The sodium retaining effects of CNIs are mediated by stimulation of the thiazide-sensitive sodium chloride co-transporter in the distal convoluted tubule and in this regard chlorthalidone was proven to be an effective antihypertensive drug in renal transplantation. (2) Local and not systemic activation of the renin-angiotensin-aldosterone system plays a crucial role in the pathogenesis of posttransplant hypertension. (3) Recent randomized controlled trials failed to prove the presumed superiority of renin-angiotensin blockers in kidney transplantation. (4) Steroid-free and mammalian target of rapamycin-based immunosuppressive drug combinations did not show favorable effects on blood pressure control. (5) In a recent report the risk of non-melanoma skin cancer was higher with thiazide diuretics. But the increased cancer risk in transplant recipients is mainly attributed to comorbidities, such as diabetes and hypertension and of course to the transplantation condition itself or the obligatory application of immunosuppression, and has little to do with the antihypertensive medication Actual recommendations about BP targets in adult renal transplant recipients are coming from a post hoc analysis of a large randomized trial with another primary endpoint. Unless convincing studies on treatment of hypertension after renal transplantation are available, the ESC/ESH Guidelines 2018 should apply for these patients.
纳入关于移植后高血压病理生理学和治疗的新发现。
（1）钙调神经磷酸酶抑制剂的保钠作用是通过刺激远曲小管中对噻嗪类敏感的氯化钠共转运体介导的，在这方面，氯噻酮被证明是肾移植中一种有效的抗高血压药物。（2）肾素 - 血管紧张素 - 醛固酮系统的局部而非全身激活在移植后高血压的发病机制中起关键作用。（3）最近的随机对照试验未能证明肾素 - 血管紧张素阻滞剂在肾移植中的假定优势。（4）无类固醇且基于雷帕霉素靶蛋白的免疫抑制药物组合对血压控制未显示出有利作用。（5）在最近的一份报告中，噻嗪类利尿剂使非黑色素瘤皮肤癌的风险更高。但移植受者癌症风险增加主要归因于合并症，如糖尿病和高血压，当然还有移植状况本身或免疫抑制的必要应用，与抗高血压药物关系不大。关于成年肾移植受者血压目标的实际建议来自一项具有另一个主要终点的大型随机试验的事后分析。除非有关于肾移植后高血压治疗的令人信服的研究，否则2018年欧洲心脏病学会/欧洲高血压学会指南应适用于这些患者。
