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Hypertension in the Kidney Transplant Recipient

Overview of Pathogenesis, Clinical Assessment, and Treatment

Glicklich, Daniel MD; Lamba, Rajat MD; Pawar, Rahul MD

doi: 10.1097/CRD.0000000000000126
Review Articles

Cardiovascular disease is the leading cause of death in patients with chronic renal disease and the most common cause of death and allograft loss among kidney transplant recipients. Transplant patients often have multiple cardiovascular risk factors antedating transplantation. Among the most prominent is hypertension (HTN), which affects at least 90% of transplant patients. Uncontrolled HTN is an independent risk factor for allograft loss. The etiology of HTN in transplant recipients is complex and multifactorial, including the use of essential immunosuppressive medications. Post-transplant HTN management requires a systematic and individualized approach with nonpharmacologic and pharmacologic therapies. There is no single ideal agent or treatment algorithm. Patients should regularly monitor and record their blood pressure at home. Often, multiple antihypertensive drugs are needed to achieve a goal blood pressure of 120–140/70–90 mm Hg. As transplant recipients commonly must take 8 to 12 different medications daily, adherence must be continually encouraged and monitored. Special attention must be paid to potential drug side effects and drug interactions with immunosuppressive medications.

From the Division of Nephrology, Department of Medicine, Westchester Medical Center, Valhalla, NY.

Disclosure: The authors have no conflicts of interest to report.

Correspondence: Daniel Glicklich MD, Renal Transplant Office, Westchester Medical Center, 100 Woods Road, Valhalla, NY 10595. E-mail:

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