Arterial hypertension in renal transplantation: Clinical implications, pathogenesis and current management strategies

Renal transplantation is the treatment of choice in end-stage kidney disease patients. Cardiovascular disease is the main cause of death in dialysis patients. The cardiovascular risk sharply declines after successful renal transplantation, but still death with a functioning graft due to cardiovascular disease is the leading cause of death in renal transplant recipients. Conventional cardiovascular risk factors such as hypertension, diabetes and hyperlipidemia which are common in transplant recipients and are associated with adverse outcomes, are accentuated by the effects of immunosuppressive drugs. More specific, arterial hypertension is a major problem in renal transplantation due to its high prevalence as well as due to its associations with cardiovascular disease and chronic allograph nephropathy. Some of the parameters implicated in the pathogenesis of post-transplant hypertension are donor and recipient factors, acute and chronic allograft injury, and immunosuppressive drugs. A significant and potentially remediable cause of resistant hypertension in renal transplant recipients is renal artery stenosis. Treatment of arterial hypertension in renal transplant patients is challenging due to the lack of established blood pressure goals, the association with multiple comorbidities and the complex immunosuppressive treatment. The aim of this review is to describe the clinical implications of increased blood pressure in renal transplant recipients, the specific settings underlying the pathogenesis of arterial hypertension in this patient population and current management strategies.