Artikel
Blood pressure and antihypertensive treatment determine long-term graft survival in kidney transplant patients
Blutdruck und antihypertensive Therapie bestimmen das Langzeittransplantatüberleben nierentransplantierter Patienten
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Autoren
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M. Hausberg
- Universitätsklinikum Münster (Münster, D)
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K. Loley
- Universitätsklinikum Münster (Münster, D)
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A. Levers
- Universitätsklinikum Münster (Münster, D)
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D. Lang
- Universitätsklinikum Münster (Münster, D)
| Veröffentlicht: | 8. August 2006 |
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Gliederung
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Objective: Many studies suggest an adverse influence of high blood pressure on kidney graft survival. However, the influence of antihypertensive treatment is less well understood.
Design and Methods: In this retrospective analysis, we included all kidney transplant patients followed at the University of Muenster renal transplant outpatient clinic who had received their graft between 1993 and 2003. Analysis was limited to those 507 patients who had a functioning graft 1 year after transplantation. All patients received a calcineurin inhibitor based immunosuppressive regimen. The goals of the present analysis were first to confirm the influence blood pressure levels on graft survival and second to compare patients who had received a combination of modern antihypertensive drugs, ACE-Inhibitors (ACEI) and calcium antagonists (CCB), for at least 2 years with patients who did not receive either of these drugs.
Results: Average follow-up was 63+2 months. One year after transplantation, blood pressure was controlled (i.e. <130/80 mmHg) in 183 patients (CTR) and not controlled in the remaining 324 patients (NON-CTR). 88,4% of the CTR-patients received antihypertensive treatment as compared to 96,6% in the NON-CTR group (p<0.05). Graft survival was significantly longer in the CTR than in the NON-CTR group (cf. figure, Breslow p<0.05). Importantly, during the first years graft survival was significantly higher in patients receiving both ACEI and CCB (n=204) as compared to patients not receiving either of these drugs (n=138) (cf. Figure 1 [Fig. 1], Breslow p<0.001), a finding more pronounced in the NON-CTR. The same was true for patients receiving ACEI alone vs. not receiving ACEI and for patients receiving CCB alone vs. not receiving CCB.
Conclusions: We conclude that blood pressure control is a strong determinant of long term graft survival in renal transplant patients. Modern antihypertensive drugs, ACEI and CCB, appear to have a beneficial effect on graft survival in renal allograft recipients.
