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Control of hypertension in children after renal transplantation
Tomás Seeman1, Eva Simková, Jirí Kreisinger
1Department of Pediatrics, University Hospital Motol, Charles University Prague, Prague, Czech Republic. tomas.seeman@lfmotol.cuni.cz
Insights
Hypertension affects nearly 90% of children post-renal transplant, with less than half achieving controlled blood pressure (BP). Optimizing antihypertensive drug regimens, particularly ACE inhibitors and diuretics, may improve BP control in these patients.
Area of Science:
- Pediatric Nephrology
- Transplantation Medicine
- Cardiovascular Health
Background:
- Hypertension is a common complication following pediatric renal transplantation.
- Effective blood pressure (BP) management is crucial for long-term graft survival and patient health.
- Ambulatory blood pressure (BP) monitoring is a key tool for assessing hypertension control in this population.
Purpose of the Study:
- To evaluate the efficacy of hypertension control in children after renal transplantation.
- To identify risk factors associated with uncontrolled hypertension in this cohort.
- To inform strategies for improving BP management post-transplant.
Main Methods:
- A cross-sectional, single-center study involving 36 children post-renal transplantation.
- Ambulatory blood pressure (BP) monitoring was used to define and assess hypertension.
- Hypertension was defined as mean ambulatory BP ≥95th percentile for age and sex, or requirement for antihypertensive medication.
Main Results:
- 89% of children exhibited hypertension, with only 55% achieving controlled BP on medication.
- Children with uncontrolled hypertension showed higher doses of immunosuppressants (cyclosporine, tacrolimus).
- A trend towards fewer antihypertensive drugs, particularly ACE inhibitors and diuretics, was observed in uncontrolled cases.
Conclusions:
- A high prevalence of hypertension exists in children post-renal transplant, with suboptimal control rates.
- Immunosuppressant medication levels and the type/number of antihypertensive agents may influence BP control.
- Strategies to enhance hypertension management, including optimizing drug regimens, are needed to improve outcomes.
Abstract:
The aim of this cross-sectional single-center study was to investigate the efficacy of hypertension control in children who underwent transplantation using ambulatory blood pressure (BP) monitoring, and to determine the risk factors associated with poor control of hypertension. Thirty-six children fulfilled the inclusion criteria. The mean age was 13.9+/-4.4 yr; the mean time after renal transplantation was 2.7+/-2.4 yr (0.5-10.1). Hypertension was defined as a mean ambulatory BP > or =95th centile for healthy children and/or requiring antihypertensive drugs. Hypertension was regarded as controlled if the mean ambulatory BP was <95th centile in children already on antihypertensive drugs, or uncontrolled if the mean ambulatory BP was > or =95th centile in treated children. Hypertension was present in 89% of children. Seventeen children (47%) had controlled hypertension, and 14 (39%) had uncontrolled hypertension. One child (3%) had untreated hypertension, and only four children (11%) showed normal BP without antihypertensive drugs. The efficacy of hypertensive control was 55% (17 of 31 children on antihypertensive drugs had a BP<95th centile), i.e. 45% of treated children still had hypertension. Children with uncontrolled hypertension had significantly higher cyclosporine doses (6.1 vs. 4.3 mg/kg/day, p=0.01) and tacrolimus levels (9.2 vs. 6.1 microg/L, p<0.05), and there was a tendency toward use of lower number of antihypertensive drugs (2.0 vs. 1.5 drugs/patient, p=0.06) and lower use of angiotensin-converting enzyme (ACE) inhibitors (7 vs. 35%, p=0.09) and diuretics (29 vs. 59%, p=0.14) than in children with controlled hypertension. In conclusion, nearly 90% of our children after renal transplantation are hypertensive and the control of hypertension is unsatisfactorily low. The control of hypertension could be improved by increasing the number of prescribed antihypertensive drugs, especially ACE inhibitors, and diuretics, or by using higher doses of currently used antihypertensives.
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