TY - JOUR
T1 - Association between early post-transplant hypertension or related antihypertensive use and prognosis of kidney transplant recipients
T2 - a nationwide observational study
AU - Park, Sehoon
AU - Kang, Sung Jin
AU - Lee, Jang Wook
AU - Kim, Ji Eun
AU - Kim, Yaerim
AU - Kim, Kwangsoo
AU - Park, Minsu
AU - Kim, Yong Chul
AU - Kim, Yon Su
AU - Lim, Yaeji
AU - Lee, Hajeong
N1 - Publisher Copyright:
© 2021, Italian Society of Nephrology.
PY - 2021/10
Y1 - 2021/10
N2 - Background: Additional research is warranted for the clinical significance of post-transplant hypertension and related antihypertensive medication use in kidney transplant (KT) recipients. Methods: This observational study included nationwide KT recipients who maintained a functioning graft for at least 1 year after KT in South Korea, observed between 2008 and 2017. The use of antihypertensive medications lasting between 6 months and 1 year was the main exposure, and those who had inconsistent/transient use of antihypertensive drugs were excluded. The prognostic outcome included death-censored graft failure (DCGF), death-with functioning graft (DWFG), and major adverse cerebrocardiovascular events (MACCEs). Results: We included 8,014 patients without post-transplant hypertension and 6,114 recipients who received treatment for hypertension in the post-transplant period. Those with post-transplant hypertension had a significantly higher risk of DCGF than those without [adjusted hazard ratio (HR) 1.27 (1.09–1.48)]. Post-transplant hypertension patients who required multiple drugs showed a significantly higher risk of DWFG [HR 1.57 (1.17–2.10)] and MACCE [HR 1.35 (1.01–1.81)] than the controls. Among the single-agent users, those who received beta-blockers showed a significantly higher risk of DCGF, although the risks of DWFG or MACCE were similar between the types of antihypertensive agents. Among the multiple agent users, the prognosis was similar, regardless of the prescribed types of antihypertensive agents. Conclusion: Post-transplant hypertension was associated with poor post-transplant prognosis, particularly when multiple types of medications were required for treatment. During initial prescription of antihypertensive medication, clinicians may consider that beta-blockers were associated with a higher risk of DCGF in the single-agent users. Graphic abstract: [Figure not available: see fulltext.]
AB - Background: Additional research is warranted for the clinical significance of post-transplant hypertension and related antihypertensive medication use in kidney transplant (KT) recipients. Methods: This observational study included nationwide KT recipients who maintained a functioning graft for at least 1 year after KT in South Korea, observed between 2008 and 2017. The use of antihypertensive medications lasting between 6 months and 1 year was the main exposure, and those who had inconsistent/transient use of antihypertensive drugs were excluded. The prognostic outcome included death-censored graft failure (DCGF), death-with functioning graft (DWFG), and major adverse cerebrocardiovascular events (MACCEs). Results: We included 8,014 patients without post-transplant hypertension and 6,114 recipients who received treatment for hypertension in the post-transplant period. Those with post-transplant hypertension had a significantly higher risk of DCGF than those without [adjusted hazard ratio (HR) 1.27 (1.09–1.48)]. Post-transplant hypertension patients who required multiple drugs showed a significantly higher risk of DWFG [HR 1.57 (1.17–2.10)] and MACCE [HR 1.35 (1.01–1.81)] than the controls. Among the single-agent users, those who received beta-blockers showed a significantly higher risk of DCGF, although the risks of DWFG or MACCE were similar between the types of antihypertensive agents. Among the multiple agent users, the prognosis was similar, regardless of the prescribed types of antihypertensive agents. Conclusion: Post-transplant hypertension was associated with poor post-transplant prognosis, particularly when multiple types of medications were required for treatment. During initial prescription of antihypertensive medication, clinicians may consider that beta-blockers were associated with a higher risk of DCGF in the single-agent users. Graphic abstract: [Figure not available: see fulltext.]
KW - Cardiovascular disease
KW - Hypertension
KW - Transplantation
UR - http://www.scopus.com/inward/record.url?scp=85114347551&partnerID=8YFLogxK
U2 - 10.1007/s40620-021-01143-6
DO - 10.1007/s40620-021-01143-6
M3 - Article
C2 - 34487334
AN - SCOPUS:85114347551
SN - 1121-8428
VL - 34
SP - 1457
EP - 1465
JO - Journal of Nephrology
JF - Journal of Nephrology
IS - 5
ER -