Role of hypertension in chronic renal allograft dysfunction

The damaging effects of essential hypertension and the central role of the kidney in its pathogenesis have long been recognized. Essential hypertension is the second leading cause of end-stage renal disease in the United States, with its prevalence increasing dramatically over the last decade. Similarly, the role of the transplanted kidney in the pathogenesis of hypertension has been demonstrated in animals and humans. Concerns over the inability of immunologic advancements to improve long-term allograft survival have focused attention on nonimmunologic factors, such as hypertension, and its contribution to chronic renal allograft injury. However, the complex nature of post-transplant hypertension has made it difficult to discern if its occurrence is the cause or the consequence of chronic allograft dysfunction. The possibility remains that, in many patients, the two processes are not mutually exclusive and coexist. Regardless, post-transplant hypertension negatively impacts long-term allograft and patient survival. Many questions regarding the etiology, optimal therapy and role of various growth factors in mediating the damaging effects of post-transplant hypertension remain unanswered and should serve as the focus for future studies.