Vnitr Lek 1999, 45(11):645-649

[Hypertension after kidney transplantation].

D Sobotová, A Zharfbin: II. vnitrní klinika Fakultní nemocnice U sv. Anny, Brno.

Hypertension is the most frequent non-rejection complication after transplantation of the kidney. It is encountered in 60 to more than 80% of recipients, depending on the investigated population and the definition of hypertension. It develops also in recipients who were normotensive before transplantation. While in dialyzed uraemic patients in the pathogenesis the most important part is played by hypervolaemia, after transplantation most frequently immunosuppressive treatment plays a part. The objective of our study was to assess the incidence of hypertension in the 1st and 2nd year after transplantation resp., the achieved blood pressure level (BP) the method of hypertension therapy in the group of recipients having immunosuppression treatment with corticoids, cyclosporin A (CyA) and mycophenolate mofetil (MFM). The group comprises 58 recipients of cadaverous renal grafts, 35 men (mean age 44.4 +/- 10.7 years and 23 women (mean age 44.8 +/- 12.6 years). 53 recipients (91.4%) had a graft for the first time, 5 recipients (8.6%) had already a second renal transplantation. Thirteen men (37%) and 8 women (35%) had a functioning graft for at least two years. The blood pressure was assessed by the auscultation method during every ambulatory control examination, with the patient sitting, on the upper extremity on the contralateral extremity with an arteriovenous fistula. The rate of ambulatory check-up examinations depended on the time after discharge from hospital following transplantation: in the first month 1x a week, in the second to third month 1x in two weeks, from the 4th month usually once a month. The BP reading at the end of the first and second year resp. after transplantation was obtained by calculating the mean value of three consecutive readings: from the ambulatory check-up at the end of the 1st and 2nd year resp. after transplantation and the preceding and subsequent check-up examination. Hypertension was defined as a BP exceeding 130/85 mm Hg or a median arterial pressure (MAP) higher than 100 mm Hg. MAP was calculated from the mean value of the SBP and DBP according to the formula: MAP = DBP + 1/3(SBP-DBP).