The Evaluation and Therapeutic Management of Hypertension in the Transplant Patient

Organ transplantation is the therapeutic option of choice in the appropriate patient with end-organ disease. A major comorbidity after the transplant is the development of hypertension which is a risk factor for cardiovascular disease. Cardiovascular disease is the most common cause of death in this population even when there is a functioning graft. It is essential to evaluate post-transplant hypertension not only in the office setting but at home and at night as well. Hence, the use of 24-h ambulatory blood pressure monitoring in both diagnosis and long-term care of this patient population is paramount. Factors involved in uncontrolled hypertension include the donor, recipient, and those specific to the transplant such as immunosuppressive drug exposure. The major offending immunosuppressive agents belong to the calcineurin inhibitor class. The therapy of post-transplant hypertension involves pharmaceutical and non-pharmaceutical interventions that should be tailored to the specific patient and type of transplant. There is clearly a need for more definitive data and quality studies in both the renal and non-renal transplant populations.