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Che L, Song W, Zhang Y, Lu Y, Cheng Y, Jiang Y. A randomized, double-blind clinical trial to evaluate the blood pressure lowing effect of low-sodium salt substitution on middle-aged and elderly hypertensive patients with different plasma renin concentrations. J Clin Hypertens (Greenwich) 2021; 24:140-147. [PMID: 34967126 PMCID: PMC8845456 DOI: 10.1111/jch.14396] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 10/12/2021] [Accepted: 11/02/2021] [Indexed: 11/27/2022]
Abstract
This study aimed to evaluate the blood pressure (BP) lowing effect of low‐sodium (LS) salt substitution and how the effect influenced by plasma renin concentration (PRC) on middle‐aged and elderly hypertensive patients. Three hundred fifty‐two hypertensives were randomized at a 1:1 ratio into a LS group and a normal salt (NS) group. We compared intergroup changes observed in office blood pressure measurement (OBPM) and home blood pressure measurement (HBPM). Then, all patients in LS group were divided into tertiles according to baseline PRC, aldosterone concentration, and aldosterone/renin ratio (ARR), and changes in OBPM and HBPM were compared across the three tertile subgroups. Follow‐up surveys were completed by 322 patients. The intergroup net reduction in systolic OBPM, systolic HBPM, and diastolic HBPM was −6.6, −4.6, and −2.3 mmHg, respectively (all P < .05), and −1.8 mmHg in diastolic OBPM (P = .068). There was a more significant reduction in OBPM and HBPM among the low baseline PRC subgroup than among the high PRC subgroup. There were no significant differences in the changes in OBPM and HBPM between the three subgroups when grouped according to baseline aldosterone concentration. The reduction in OBPM and HBPM in the high tertile of ARR was larger than that in the low tertile subgroup. LS salt substitution is effective in reducing systolic OBPM, systolic HBPM, and diastolic HBPM in middle‐aged and elderly hypertensive patients. LS salt substitution may offer a non‐pharmaceutical therapy for hypertensive patients. Baseline PRC may be a marker to predict BP response after salt restriction.
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Affiliation(s)
- Li Che
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Wei Song
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Ying Zhang
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Yan Lu
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Yunpeng Cheng
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Yinong Jiang
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
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Siddiqui M, Judd EK, Jaeger BC, Bhatt H, Dudenbostel T, Zhang B, Edwards LJ, Oparil S, Calhoun DA. Out-of-Clinic Sympathetic Activity Is Increased in Patients With Masked Uncontrolled Hypertension. Hypertension 2019; 73:132-141. [PMID: 30571547 DOI: 10.1161/hypertensionaha.118.11818] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Masked uncontrolled hypertension (MUCH) is defined as controlled automated office blood pressure (BP; AOBP <135/85 mm Hg) in-clinic in patients receiving antihypertensive medication(s) but uncontrolled BP out-of-clinic by 24-hour ambulatory BP monitoring (ABPM; awake ≥135/85 mm Hg). We hypothesized that MUCH patients have greater out-of-clinic sympathetic activity compared with true controlled hypertensives. Patients being treated for hypertension were prospectively recruited after 3 or more consecutive clinic visits. All patients were evaluated by in-clinic automated office BP, plasma catecholamines, and spot-urine/plasma metanephrines. In addition, out-of-clinic 24-hour ABPM, 24-hour urinary for catecholamines and metanephrines was done. Out of 237 patients recruited, 169 patients had controlled in-clinic BP of which 156 patients had completed ABPM. Seventy-four were true controlled hypertensives, that is controlled by clinic automated office BP and by out-of-clinic ABPM. The remaining 82 were controlled by clinic automated office BP, but uncontrolled during out-of-clinic ABPM, indicative of MUCH. After exclusion of 4 patients because of inadequate or lack of 24-hour urinary collections, 72 true controlled hypertensive and 80 MUCH patients were analyzed. MUCH patients had significantly higher out-of-clinic BP variability and lower heart rate variability compared with true controlled hypertensives, as well as higher levels of out-of-clinic urinary catecholamines and metanephrines levels consistent with higher out-of-clinic sympathetic activity. In contrast, there was no difference in in-clinic plasma catecholamines and spot-urine/plasma levels of metanephrines between the 2 groups, consistent with similar levels of sympathetic activity while in clinic. MUCH patients have evidence of heightened out-of-clinic sympathetic activity compared with true controlled hypertensives, which may contribute to the development of MUCH.
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Affiliation(s)
- Mohammed Siddiqui
- From the Vascular Biology and Hypertension Program, Division of Cardiovascular Disease (M.S., T.D., S.O., D.A.C.), University of Alabama at Birmingham
| | - Eric K Judd
- Division of Nephrology (E.K.J.), University of Alabama at Birmingham
| | - Byron C Jaeger
- School of Medicine, Department of Biostatistics, School of Public Health (B.C.J., L.J.E.), University of Alabama at Birmingham
| | - Hemal Bhatt
- Division of Cardiovascular Disease, Einstein Medical Center, Philadelphia, Pennsylvania (H.B.)
| | - Tanja Dudenbostel
- From the Vascular Biology and Hypertension Program, Division of Cardiovascular Disease (M.S., T.D., S.O., D.A.C.), University of Alabama at Birmingham
| | - Bin Zhang
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Ohio (B.Z.)
| | - Lloyd J Edwards
- School of Medicine, Department of Biostatistics, School of Public Health (B.C.J., L.J.E.), University of Alabama at Birmingham
| | - Suzanne Oparil
- From the Vascular Biology and Hypertension Program, Division of Cardiovascular Disease (M.S., T.D., S.O., D.A.C.), University of Alabama at Birmingham
| | - David A Calhoun
- From the Vascular Biology and Hypertension Program, Division of Cardiovascular Disease (M.S., T.D., S.O., D.A.C.), University of Alabama at Birmingham
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Siddiqui M, Judd EK, Dudenbostel T, Zhang B, Gupta P, Tomaszewski M, Patel P, Oparil S, Calhoun DA. Masked Uncontrolled Hypertension Is Not Attributable to Medication Nonadherence. Hypertension 2019; 74:652-659. [PMID: 31327263 DOI: 10.1161/hypertensionaha.119.13258] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Masked uncontrolled hypertension (MUCH) in treated hypertensive patients is defined as controlled automated office blood pressure (BP; <135/85 mm Hg) in-clinic but uncontrolled out-of-clinic BP by ambulatory BP monitoring (awake [daytime] readings ≥135/85 mm Hg or 24-hour readings ≥130/80 mm Hg). To determine whether MUCH is attributable to antihypertensive medication nonadherence. One hundred eighty-four enrolled patients were confirmed to have controlled office BP; of these, 167 patients were with adequate 24-hour ambulatory BP recordings. Of 167 patients, 86 were controlled by in-clinic BP assessment but had uncontrolled ambulatory awake BP, indicative of MUCH. The remaining 81 had controlled in-clinic and ambulatory awake BP, consistent with true controlled hypertension. After exclusion of 9 patients with missing 24-hour urine collections, antihypertensive medication adherence was determined based on the detection of urinary drugs or drug metabolites by high-performance liquid chromatography-tandem mass spectrometry. Of the 81 patients with MUCH, 69 (85.2%) were fully adherent and 12 (14.8%) were partially adherent (fewer medications detected than prescribed). Of the 77 patients with true controlled hypertension, 69 (89.6%) were fully adherent with prescribed antihypertensive medications and 8 (10.4%) were partially adherent. None of the patients in either group were fully nonadherent. There was no statistically significant difference in complete or partial adherence between the MUCH and true controlled groups (P=0.403). Measurement of urinary drug and drug metabolite levels demonstrates a similarly high level of antihypertensive medication adherence in both MUCH and truly controlled hypertensive patients. These findings indicate that MUCH is not attributable to antihypertensive medication nonadherence.
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Affiliation(s)
- Mohammed Siddiqui
- From the Vascular Biology and Hypertension Program (M.S., T.D., S.O., D.A.C.), University of Alabama at Birmingham
| | - Eric K Judd
- Division of Nephrology (E.K.J.), University of Alabama at Birmingham
| | - Tanja Dudenbostel
- From the Vascular Biology and Hypertension Program (M.S., T.D., S.O., D.A.C.), University of Alabama at Birmingham
| | - Bin Zhang
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, OH (B.Z.).,Department of Pediatrics, University of Cincinnati College of Medicine, University of Cincinnati, OH (B.Z.)
| | - Pankaj Gupta
- Department of Chemical Pathology and Metabolic Medicine, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P.).,Department of Cardiovascular Sciences, University of Leicester, United Kingdom (P.G., P.P.)
| | - Maciej Tomaszewski
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom (M.T.)
| | - Prashanth Patel
- Department of Chemical Pathology and Metabolic Medicine, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P.).,Department of Cardiovascular Sciences, University of Leicester, United Kingdom (P.G., P.P.)
| | - Suzanne Oparil
- From the Vascular Biology and Hypertension Program (M.S., T.D., S.O., D.A.C.), University of Alabama at Birmingham
| | - David A Calhoun
- From the Vascular Biology and Hypertension Program (M.S., T.D., S.O., D.A.C.), University of Alabama at Birmingham
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Severova-Andreevska G, Danilovska I, Sikole A, Popov Z, Ivanovski N. Hypertension after Kidney Transplantation: Clinical Significance and Therapeutical Aspects. Open Access Maced J Med Sci 2019; 7:1241-1245. [PMID: 31049114 PMCID: PMC6490475 DOI: 10.3889/oamjms.2019.264] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 04/02/2019] [Accepted: 04/03/2019] [Indexed: 12/14/2022] Open
Abstract
Most of the kidney transplanted patients develop arterial hypertension after renal transplantation. Together with very well-known and usual risk factors, post-transplant hypertension contributes to the whole cardiovascular morbidity and mortality in the kidney transplant population. The reasons of post-transplant hypertension are factors related to donors and recipients, immunosuppressive therapy like Calcineurin Inhibitors (CNI) and surgery procedures (stenosis and kinking of the renal artery and ureteral obstruction). According to Eighth National Committee (JNC 8) recommendations, blood pressure > 140/90 mmHg is considered as hypertension. The usual antihypertensive drugs used for the control of hypertension are Calcium channel blockers (CCB), Angiotensin-converting enzyme (ACE) inhibitors, Angiotensin -II receptor blockers (ARB), B- blockers and diuretics. Follow the KDIGO guidelines the target blood pressure < 140/90 mmHg for patients without proteinuria and < 125/75 mmHg in patients with proteinuria is recommended. Better control of post-transplant hypertension improves the long-term graft and patient's survival.
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Affiliation(s)
- Galina Severova-Andreevska
- University Clinic of Nephrology, Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Ilina Danilovska
- University Clinic of Nephrology, Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Aleksandar Sikole
- University Clinic of Nephrology, Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Zivko Popov
- Macedonian Academy for Science and Arts, Skopje, Republic of Macedonia
- Zan Mitrev Clinic, Skopje, Republic of Macedonia
| | - Ninoslav Ivanovski
- Zan Mitrev Clinic, Skopje, Republic of Macedonia
- Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
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Unique Considerations When Managing Hypertension in the Transplant Patient. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016. [PMID: 27815930 DOI: 10.1007/5584_2016_87] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Abstract
For the select fortunate recipients of organ transplants, transplantation affords the rare opportunity for a new life. Given the scarcity of organs for transplantation, it is imperative that the health of transplant recipients be optimized in order to fully benefit from this gift of life. Unfortunately, hypertension is highly prevalent in the transplant population and it is considered a major cardiovascular risk factor contributing to mortality and morbidity in this population. In this chapter, we expound on the epidemiology, unique pathophysiology, evaluation, and management of hypertension as it pertains to the solid organ transplant recipient. In addition, a brief commentary is made on the subject of hypertension following living kidney donation, and practical aspects of management of hypertension in the solid organ recipient are summarized at the end of the chapter.
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van Lint CL, van der Boog PJM, Wang W, Brinkman WP, Rövekamp TJM, Neerincx MA, Rabelink TJ, van Dijk S. Patient experiences with self-monitoring renal function after renal transplantation: results from a single-center prospective pilot study. Patient Prefer Adherence 2015; 9:1721-31. [PMID: 26673985 PMCID: PMC4676625 DOI: 10.2147/ppa.s92108] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND After a kidney transplantation, patients have to visit the hospital often to monitor for early signs of graft rejection. Self-monitoring of creatinine in addition to blood pressure at home could alleviate the burden of frequent outpatient visits, but only if patients are willing to self-monitor and if they adhere to the self-monitoring measurement regimen. A prospective pilot study was conducted to assess patients' experiences and satisfaction. MATERIALS AND METHODS For 3 months after transplantation, 30 patients registered self-measured creatinine and blood pressure values in an online record to which their physician had access to. Patients completed a questionnaire at baseline and follow-up to assess satisfaction, attitude, self-efficacy regarding self-monitoring, worries, and physician support. Adherence was studied by comparing the number of registered with the number of requested measurements. RESULTS Patients were highly motivated to self-monitor kidney function, and reported high levels of general satisfaction. Level of satisfaction was positively related to perceived support from physicians (P<0.01), level of self-efficacy (P<0.01), and amount of trust in the accuracy of the creatinine meter (P<0.01). The use of both the creatinine and blood pressure meter was considered pleasant and useful, despite the level of trust in the accuracy of the creatinine device being relatively low. Trust in the accuracy of the creatinine device appeared to be related to level of variation in subsequent measurement results, with more variation being related to lower levels of trust. Protocol adherence was generally very high, although the range of adherence levels was large and increased over time. CONCLUSION Patients' high levels of satisfaction suggest that at-home monitoring of creatinine and blood pressure after transplantation offers a promising strategy. Important prerequisites for safe implementation in transplant care seem to be support from physicians and patients' confidence in both their own self-monitoring skills and the accuracy of the devices used.
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Affiliation(s)
- Céline L van Lint
- Department of Nephrology, Leiden University Medical Centre (LUMC), Leiden, the Netherlands
- Correspondence: Céline L van Lint, Department of Nephrology, Leiden University Medical Centre (LUMC), PO Box 9600, Leiden 2300 RC, the Netherlands, Tel +31 71 526 2214, Email
| | - Paul JM van der Boog
- Department of Nephrology, Leiden University Medical Centre (LUMC), Leiden, the Netherlands
| | - Wenxin Wang
- Faculty of Electrical Engineering, Mathematics and Computer Science, Delft University of Technology, Delft, the Netherlands
- Department of Technology in Healthcare, Prevention and Health, Dutch Organization for Applied Scientific Research (TNO), Leiden, the Netherlands
| | - Willem-Paul Brinkman
- Faculty of Electrical Engineering, Mathematics and Computer Science, Delft University of Technology, Delft, the Netherlands
| | - Ton JM Rövekamp
- Department of Technology in Healthcare, Prevention and Health, Dutch Organization for Applied Scientific Research (TNO), Leiden, the Netherlands
| | - Mark A Neerincx
- Faculty of Electrical Engineering, Mathematics and Computer Science, Delft University of Technology, Delft, the Netherlands
| | - Ton J Rabelink
- Department of Nephrology, Leiden University Medical Centre (LUMC), Leiden, the Netherlands
| | - Sandra van Dijk
- Department of Nephrology, Leiden University Medical Centre (LUMC), Leiden, the Netherlands
- Department of Health, Medical and Neuropsychology, Faculty of Social and Behavioural Sciences, Leiden University, Leiden, the Netherlands
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David VG, Yadav B, Jeyaseelan L, Deborah MN, Jacob S, Alexander S, Varughese S, John GT. Prospective blood pressure measurement in renal transplant recipients. Indian J Nephrol 2014; 24:154-60. [PMID: 25120292 PMCID: PMC4127834 DOI: 10.4103/0971-4065.132006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Blood pressure (BP) control at home is difficult when managed only with office blood pressure monitoring (OBPM). In this prospective study, the reliability of BP measurements in renal transplant patients with OBPM and home blood pressure monitoring (HBPM) was compared with ambulatory blood pressure monitoring (ABPM) as the gold standard. Adult patients who had living-related renal transplantation from March 2007 to February 2008 had BP measured by two methods; OBPM and ABPM at pretransplantation, 2nd, 4th, 6th, and 9th months and all the three methods: OBPM, ABPM, and HBPM at 6 months after transplantation. A total of 49 patients, age 35 ± 11 years, on prednisolone, tacrolimus, and mycophenolate were evaluated. A total of 39 were males (79.6%). Systolic BP (SBP) and diastolic BP (DBP) measured by OBPM were higher than HBPM when compared with ABPM. When assessed using OBPM and awake ABPM, both SBP and DBP were significantly overestimated by OBPM with mean difference of 3-12 mm Hg by office SBP and 6-8 mm Hg for office DBP. When HBPM was compared with mean ABPM at 6 months both the SBP and DBP were overestimated by and 7 mm Hg respectively. At 6 months post transplantation, when compared with ABPM, OBPM was more specific than HBPM in diagnosing hypertension (98% specificity, Kappa: 0.88 vs. 89% specificity, Kappa: 0.71). HBPM was superior to OBPM in identifying patients achieving goal BP (89% specificity, Kappa: 0.71 vs. 50% specificity Kappa: 0.54). In the absence of a gold standard for comparison the latent class model analysis still showed that ABPM was the best tool for diagnosing hypertension and monitoring patients reaching targeted control. OBPM remains an important tool for the diagnosis and management of hypertension in renal transplant recipients. HBPM and ABPM could be used to achieve BP control.
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Affiliation(s)
- V G David
- Department of Nephrology, Christian Medical College/Hospital, Vellore, Tamil Nadu, India
| | - B Yadav
- Department of Biostatics, Christian Medical College/Hospital, Vellore, Tamil Nadu, India
| | - L Jeyaseelan
- Department of Biostatics, Christian Medical College/Hospital, Vellore, Tamil Nadu, India
| | - M N Deborah
- Department of Nephrology, Christian Medical College/Hospital, Vellore, Tamil Nadu, India
| | - S Jacob
- Department of Nephrology, Christian Medical College/Hospital, Vellore, Tamil Nadu, India
| | - S Alexander
- Department of Nephrology, Christian Medical College/Hospital, Vellore, Tamil Nadu, India
| | - S Varughese
- Department of Nephrology, Christian Medical College/Hospital, Vellore, Tamil Nadu, India
| | - G T John
- Department of Renal Unit, Royal Brisbane and Women's Hospital, QLD, Australia
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Kayrak M, Gul EE, Kaya C, Solak Y, Turkmen K, Yazici R, Guney I, Altintepe L, Turk S, Ozdemir K. Masked hypertension in renal transplant recipients. Blood Press 2013; 23:47-53. [PMID: 23721572 DOI: 10.3109/08037051.2013.796688] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Arterial hypertension is a risk factor affecting graft function in renal transplant recipients (RTRs). In pediatric RTRs, high prevalence of masked and nocturnal hypertension was reported. Most of the RTRs had a history of hypertension and some of them were normotensive at outpatient visits whereas home blood pressure (BP) levels were higher. Masked hypertension (MHT) is defined as a normal office BP but an elevated ambulatory BP. Previous reports have demonstrated the detrimental role of MHT in clinical outcomes in hypertensive patients. However, the true prevalence of MHT in RTRs is yet to be defined. METHODS A total of 113 RTRs (mean age 44 ± 16 years, 72 males, 41 females) with normal office BP (< 140/90 mmHg) were enrolled to the study from the outpatient renal transplantation clinic. Ambulatory BP monitoring (ABPM) was performed in all participants for a 24-h period. Average daytime BP values above 135 mmHg systolic and 85 mmHg diastolic were defined as MHT. RESULTS The prevalence of MHT in our cohort was 39% (n = 45). Fasting glucose and C-reactive protein levels were higher in patients with MHT compared with normal BP group (p = 0.02 and p = 0.04, respectively). RTRs with deceased donor type had higher prevalence of MHT than RTRs with living donor (40% vs 19%, p = 0.003). In multivariate analysis, deceased donor type could predict the MHT independent of age, gender, office systolic BP level, diabetes mellitus, serum creatinine, C-reactive protein, and glucose levels (OR = 3.62, 95% CI 1.16-11.31, p = 0.03). CONCLUSION We demonstrated an increased prevalence of MHT in a typical renal transplant cohort. In addition, transplantation from a deceased donor may be a predictor of MHT. The prevalence of MHT may help to explain high rate of cardiovascular events in RTRs. Therefore, routine application of ABPM in RTRs may be plausible, particularly in RTRs with deceased donor type.
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Affiliation(s)
- Mehmet Kayrak
- Department of Cardiology, Meram School of Medicine, Necmettin Erbakan University , Konya , Turkey
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Aparicio LS, Alfie J, Barochiner J, Cuffaro PE, Rada M, Morales M, Galarza C, Waisman GD. Hypertension: The Neglected Complication of Transplantation. ACTA ACUST UNITED AC 2013. [DOI: 10.5402/2013/165937] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Arterial hypertension and transplantation are closely linked, and its association may promote impaired graft and overall survival. Since the introduction of calcineurin inhibitors, it is observed in 50–80% of transplanted patients. However, many pathophysiological mechanisms are involved in its genesis. In this review, we intend to provide an updated overview of these mechanisms, dealing with the causes common to all kinds of transplantation and emphasizing special cases with distinct features, and to give a perspective on the pharmacological approach, in order to help clinicians in the management of this frequent complication.
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Affiliation(s)
- Lucas S. Aparicio
- Hypertension Section, Internal Medicine Department, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1181ACH Buenos Aires, Argentina
| | - José Alfie
- Hypertension Section, Internal Medicine Department, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1181ACH Buenos Aires, Argentina
| | - Jessica Barochiner
- Hypertension Section, Internal Medicine Department, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1181ACH Buenos Aires, Argentina
| | - Paula E. Cuffaro
- Hypertension Section, Internal Medicine Department, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1181ACH Buenos Aires, Argentina
| | - Marcelo Rada
- Hypertension Section, Internal Medicine Department, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1181ACH Buenos Aires, Argentina
| | - Margarita Morales
- Hypertension Section, Internal Medicine Department, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1181ACH Buenos Aires, Argentina
| | - Carlos Galarza
- Hypertension Section, Internal Medicine Department, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1181ACH Buenos Aires, Argentina
| | - Gabriel D. Waisman
- Hypertension Section, Internal Medicine Department, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1181ACH Buenos Aires, Argentina
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