Blood pressure control after solid organ transplantation: opportunities for optimizing care

Hypertension affects 50%-90% of solid organ transplant recipients (SOTR) and is a major driver of cardiovascular disease. Nevertheless, hypertension control has received little attention in this population. We assessed blood pressure control 1 year after heart, liver, lung or kidney transplantation using cross-sectional data from 1112 SOTR (39% female, mean age 57 ± 13 years) from the TransplantLines biobank and cohort study. Suboptimal control was defined as systolic blood pressure >130 mmHg or diastolic blood pressure >80 mmHg. Overall, 997 (90%) SOTR had hypertension. Suboptimal control occurred in 721 (72%), including 146 (20%) who received no antihypertensive treatment despite elevated blood pressure. Rates of suboptimal control were consistently high across organ types (71%-84%). Older age (OR = 1.03; 95%CI1.01-1.04), diabetes (OR = 1.99; 95%CI1.18-3.36), and higher cholesterol (OR = 1.23; 95%CI1.01-1.51) were independently associated with suboptimal control. Among treated SOTR, recipients were older (OR = 1.03; 95%CI1.01-1.05), more often male (OR = 1.55; 95%CI1.03-2.34), and had more prior cardiovascular events (OR = 2.06; 95%CI1.14-3.95). In sensitivity analyses using alternative blood pressure thresholds, suboptimal control remained common, affecting 40% of hypertensive SOTR using a ≤140/90 mmHg threshold. In conclusion, nearly three out of four hypertensive SOTR have suboptimal blood pressure control at 1 year after transplantation with a ≤130/80 mmHg threshold, highlighting a substantial care gap in post-transplant management.