Hypertension consitutes a risk of dialysis and death in renal transplantation. Little is known regarding the predictive value of the nature and number of the anti-hypertensive medications, independently of blood pressure control.Design and method:
During the 1985–2014 period, 1986 patients were received a kidney graft in the Tours University Hospital, France. They were followed up during a median period of 7.5 years (range: 0.1 to 29.5). The predictive value of blood pressure control and management at 12 months following transplantation on the subsequent risk of death and return to dialysis was estimated.Results:
At 12 months following transplantation, 1797 (89.0%) patients had a functional graft. Overall, 52.9% had a blood pressure > 140 and/or 90 mmHg. Among them, only 33.3% had 3 or more antihypertensive medications. During follow-up, 228 patients died and 348 returned to dialysis.Results:
Systolic arterial pressure was associated with an increased risk of death (HR per 10 mmHg: 1.22 [1.14–1.31], P < 0.0001) and dialysis (HR per 10 mmHg: 1.12 [1.06–1.19], P = 0.0002). However, the use of 3 or more antihypertensive medications (vs < 3 antihypertensive medications) was associated with an increased risk of death (HR: 1.71 [1.10–2.65], P = 0.0165) and dialysis (HR: 2.48 [1.69–3.64], P < 0.0001) after adjustment on age, sex and blood pressure control. No meaningful relationship between the use of specific antihypertensive drugs and the risk of death and dialysis.Conclusions:
The need for multiple antihypertensive drugs is a predictor of death and dialysis independently of blood pressure control in renal transplant recipients.