Factors determining the prevalence of hypertension after renal transplantation

The prevalence of hypertension was studied in renal transplant recipients followed for at least 1 year. Twenty-eight patients with a transplant renal artery stenosis, all with hypertension, were excluded from further study. Hypertension was present at 1 year after transplantation in 48.3% of 329 cadaveric renal graft recipients, treated with azathioprine. These hypertensive patients had experienced more rejection episodes. The prevalence of hypertension was higher in patients with (n = 237) than in those without (n = 92) host kidneys in situ (57.8% and 23.9% respectively, P less than 0.001). In patients with host kidney, the prevalence of hypertension was higher in patients with glomerulonephritis (n = 108) than in those in whom interstitial nephritis (n = 63) was the original renal disease (71.3% and 42.8 respectively, P less than 0.001). In 41 patients initially treated with cyclosporin and in 42 recipients of a kidney from a living donor, the prevalence of hypertension was not clearly lower than in the azathioprine-treated patients. In 30 patients without host-kidneys who did not experience acute rejections, only three had hypertension. In all three patients a specific cause for the hypertension was found. In hypertensive patients, blood pressure decreased gradually in the years following transplantation. In conclusion, besides transplant renal artery stenosis, the main determinants of the prevalence of hypertension after renal transplantation are host kidneys original renal disease, and rejection.