Arterial hypertension in kidney transplantation: huge importance, but few answers

Abstract Arterial hypertension (AH) after renal transplantation (RTX) is correlated with worse cardiovascular and renal outcomes, with loss of renal function, decreased graft survival and higher mortality. RTX recipients have discrepant blood pressure (BP) values when measured in the office or by systematic methodologies, such as Ambulatory Blood Pressure Monitoring (ABPM), with significant prevalence of no nocturnal dipping or nocturnal hypertension, white coat hypertension and masked hypertension. The aim of the present study was to review the issue of hypertension in RTX, addressing its multifactorial pathophysiology and demonstrating the importance of ABPM as a tool for monitoring BP in these patients. Treatment is based on lifestyle changes and antihypertensive drugs, with calcium channel blockers considered first-line treatment. The best blood pressure target and treatment with more favorable outcomes in RTX are yet to be determined, through well-conducted scientific studies, that is, in terms of AH in RTX, we currently have more questions to answer than answers to give.

肾移植（renal transplantation, RTX）术后动脉高血压（arterial hypertension, AH）与较差的心血管及肾脏结局相关，可引发肾功能下降、移植物存活率降低及死亡率升高。肾移植受者在诊室或通过动态血压监测（ambulatory blood pressure monitoring, ABPM）等系统方法测得的血压（blood pressure, BP）数值存在差异，其中非杓型血压或夜间高血压、白大衣高血压及隐匿性高血压的患病率较高。本研究旨在综述肾移植术后高血压相关问题，探讨其多因素病理生理机制，并阐明动态血压监测作为此类患者血压监测工具的重要性。肾移植术后高血压的治疗基于生活方式干预与降压药物治疗，其中钙通道阻滞剂被视为一线治疗方案。目前，肾移植术后高血压的最佳血压控制目标及可带来更优结局的治疗方案仍需通过严谨开展的科学研究加以明确，换言之，针对肾移植术后动脉高血压，当前亟待解答的问题多于已有定论的答案。