신장 이식 후 고혈압 환자에서 약제 선택, Hypertension After Renal Transplantation, BP-lowering agent
Synopsis
BP targets change over time after transplantation. Initially, it is important to maintain ample organ perfusion with less stringent BP targets (<160/90 mm Hg) to avoid hypotension and risk of graft thrombosis. Beyond the first month, BP should be controlled to prevent target organ damage as in the nontransplantation setting . Hypertension after transplantation is often associated with altered circadian BP rhythm with loss of the normal nocturnal BP fall and, in some, a nocturnal BP rise. These changes may return to normal after a longer period of follow-up.
Recommendation-Specific Supportive Text
1. Although treatment targets for hypertension after transplantation should probably be similar to those for other patients with CKD, there are no trials in post-transplantation patients comparing different BP targets. As kidney transplant recipients generally have a single functioning kidney and CKD, BP targets should be similar to those for the general CKD population.
2. Limited studies have compared drug choice for initial antihypertensive therapy in patients after kidney transplantation. On the basis of a Cochrane analysis, most studies favor CCBs to reduce graft loss and maintain higher GFR, with some evidence suggesting potential harm from ACE inhibitors because of anemia, hyperkalemia, and lower GFR. In recognition of this concern, RAS inhibitors may be reserved for the subset of patients with hypertension and additional comorbidities that support the need for ACE inhibitor therapy (i.e., proteinuria or HF after transplantation). With appropriate potassium and creatinine monitoring, this has been demonstrated to be safe.
