Clinical characteristics of resistant hypertension in renal transplant patients

Hypertension is a prevalent complication that occurs in 80-85% of all kidney transplant recipients. The pathogenesis of post-transplant hypertension is multifactorial and includes pre-transplant hypertension, donor hypertension, renin secretion from the native kidney, graft dysfunction, recurrent disease and immunosuppressive treatment. Hypertension negatively affects transplant and patient survival outcomes; cardiovascular disease (CVD) is the leading cause of morbidity and mortality in patients with chronic renal disease and after successful renal transplantation. Hypertension is a well-known risk factor for CVD and it is frequently associated with other CVD risk factors. Despite increased awareness of the adverse effects of hypertension in both graft and patient survival, long-term studies have shown that arterial hypertension in the transplant population has not been adequately controlled. Resistant hypertension (RH) is defined as office blood pressure (oBP) that remains above goal (oBP ≥ 140/90 or 130/80 mmHg) in patients with diabetes or chronic kidney disease despite the concurrent use of three antihypertensive agents, at full doses, one of them being a diuretic. Despite studies in the general population and the high prevalence of hypertension in renal transplant patients, data about RH are very scarce and the prevalence of RH in renal transplant patients is unknown and could be associated with a worse prognosis.