Alexandrou Maria-Eleni, Ferro Charles J, Boletis Ioannis, Papagianni Aikaterini, Sarafidis Pantelis
Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki 54642, Greece.
Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2WB, United Kingdom.
World J Transplant. 2022 Aug 18;12(8):211-222. doi: 10.5500/wjt.v12.i8.211.
Kidney transplantation is considered the treatment of choice for end-stage kidney disease patients. However, the residual cardiovascular risk remains significantly higher in kidney transplant recipients (KTRs) than in the general population. Hypertension is highly prevalent in KTRs and represents a major modifiable risk factor associated with adverse cardiovascular outcomes and reduced patient and graft survival. Proper definition of hypertension and recognition of special phenotypes and abnormal diurnal blood pressure (BP) patterns is crucial for adequate BP control. Misclassification by office BP is commonly encountered in these patients, and a high proportion of masked and uncontrolled hypertension, as well as of white-coat hypertension, has been revealed in these patients with the use of ambulatory BP monitoring. The pathophysiology of hypertension in KTRs is multifactorial, involving traditional risk factors, factors related to chronic kidney disease and factors related to the transplantation procedure. In the absence of evidence from large-scale randomized controlled trials in this population, BP targets for hypertension management in KTR have been extrapolated from chronic kidney disease populations. The most recent Kidney Disease Improving Global Outcomes 2021 guidelines recommend lowering BP to less than 130/80 mmHg using standardized BP office measurements. Dihydropyridine calcium channel blockers and angiotensin-converting enzyme inhibitors/angiotensin-II receptor blockers have been established as the preferred first-line agents, on the basis of emphasis placed on their favorable outcomes on graft survival. The aim of this review is to provide previous and recent evidence on prevalence, accurate diagnosis, pathophysiology and treatment of hypertension in KTRs.
肾移植被认为是终末期肾病患者的首选治疗方法。然而，肾移植受者（KTRs）的残余心血管风险仍显著高于普通人群。高血压在KTRs中非常普遍，是与不良心血管结局以及患者和移植物存活率降低相关的主要可改变风险因素。正确定义高血压并识别特殊表型和异常的昼夜血压模式对于充分控制血压至关重要。这些患者中常见因诊室血压导致的分类错误，并且通过动态血压监测发现这些患者中隐匿性和未控制的高血压以及白大衣高血压的比例很高。KTRs中高血压的病理生理学是多因素的，涉及传统风险因素、与慢性肾病相关的因素以及与移植手术相关的因素。由于缺乏该人群大规模随机对照试验的证据，KTRs高血压管理的血压目标是从慢性肾病人群推断而来的。最新的2021年改善全球肾脏病预后组织指南建议使用标准化的诊室血压测量方法将血压降至低于130/80 mmHg。基于对二氢吡啶类钙通道阻滞剂和血管紧张素转换酶抑制剂/血管紧张素II受体阻滞剂对移植物存活的有利结果的重视，它们已被确立为首选的一线药物。本综述的目的是提供关于KTRs中高血压的患病率、准确诊断、病理生理学和治疗的既往和最新证据。
