In:
Annals of Medicine & Surgery, Ovid Technologies (Wolters Kluwer Health), Vol. 85, No. 6 ( 2023-05-10), p. 2362-2367
Abstract:
There are limited data on why some kidney transplant (KTx) recipients (KTRs) have ‘difficult-to-control (DTC) hypertension’ requiring greater than or equal to 2 antihypertensive medications while others require less antihypertensive medications post-KTx. Methods: The authors reviewed the pre-KTx cardiovascular (CV) imaging, and the changes of CV risk factors during the first-year post-KTx. The authors divided patients according to the number of their blood pressure medications at one year into two groups: requiring less than or equal to 1 and requiring greater than or equal to 2 medications (DTC hypertension). The target blood pressure during the time of this study was less than 140/90 mmHg. Results: Two hundred forty-five KTRs were included with an average age of 43.2. 56.3% were male and 79.2% were living donor KTRs. Pre-emptive KTx was 6.5%, previous coronary artery disease was 12.7%, diabetes and smoking 40.8 and 9%, respectively. 38% of the patients had DTC HTN. Risk factors were age ( P 〈 0.01), pre-KTx hypertension ( P 〈 0.01), and diabetes mellitus ( P 〈 0.01). Dialysis vintage, type of dialysis, type of KTx, and smoking were not different between the groups. Patients with abnormal pre-KTx CV imaging, including abnormal ejection fraction less than 55% ( P =0.03), abnormal wall motion on echocardiography ( P 〈 0.01), abnormal perfusion stress test ( P 〈 0.01), higher calcium scoring ( P 〈 0.01), abnormal cardiac catheterization ( P 〈 0.01), or higher degree of calcifications on CT of pelvic arteries ( P 〈 0.01) were at higher risk of DTC hypertension. Post-KTx factors including rejection, change in serum creatinine and weight, A1c, new-onset diabetes post-KTx, and persistent hyperparathyroidism were not different between the groups. Multivariate analysis revealed associations with age (aOR=1.027), male sex (aOR=2.057), baseline diabetes mellitus (aOR=2.065), baseline HTN (aOR=2.82), and use of greater than or equal to 2 antihypertensive medications at 1-month post-KTx (aOR=6.146). Conclusion: At one year post transplantation, about a third of the KTRs required had DTC HTN. These patients were more likely to be older, males, diabetics, previously hypertensive, on greater than or equal to 2 HTN medications at 1-month post-KTx, and to have abnormal baseline pretransplant CV imaging.
Type of Medium:
Online Resource
ISSN:
2049-0801
DOI:
10.1097/MS9.0000000000000817
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2023
detail.hit.zdb_id:
2745440-X
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