[Hypertension after kidney transplantation]

Cardiovascular disease (CVD) is the leading cause of death among renal transplant recipients. The prevalence and severity of CVD in renal transplant recipients are related to numerous factors, most shared with the general population and others specific to transplant recipients, including effects of kidney dysfunction and immunosuppressive drugs. Arterial hypertension is highly prevalent after renal transplantation and may contribute to the risk of cardiovascular disease and graft failure. Immunosuppressive drugs such as corticosteroids, cyclosporine and tacrolimus may be important contributing factors to post-transplant hypertension. Recent data suggest that renal transplant patients under tacrolimus-based therapy showed less arterial hypertension compared with cyclosporine treated patients. New immunosuppressive drugs, including mycophenolate mofetil and sirolimus, are not nephrotoxic, do not have any hypertensive effect and may permit several combinations that offer important alternatives to classical immunosuppressive regimens to reduce the incidence and clinical impact of arterial hypertension after renal transplantation. Other metabolic disorders, such as post-transplant dyslipidemia and diabetes have to be closely monitored and treated as soon as possible. Incidence of arterial hypertension after kidney transplantation may be reduced by early detection, proper adjustment of immunosuppressive protocols and aggressive treatment with lifestyle modification and potent antihypertensive drugs.