Improved control of hypertension in children after renal transplantation: Results of a two-yr interventional trial
Abstract
Hypertension is a frequent complication in children after renal transplantation and the control of post-transplant hypertension is unsatisfactorily low. The aim of this prospective interventional study was to improve the control of hypertension in children after renal transplantation.
Thirty-six children fulfilled the inclusion criteria (GREATER-THAN OR EQUAL TO6 months after transplantation and no acute rejection in the last three months). BP was measured using ABPM.
Hypertension was defined as mean ambulatory BP GREATER-THAN OR EQUAL TO95th-centile for healthy children and/or using antihypertensive drugs. The study intervention consisted of using intensified antihypertensive drug therapy - in children with uncontrolled hypertension (i.e., mean ambulatory BP was GREATER-THAN OR EQUAL TO95th centile in treated children), antihypertensive therapy was intensified by adding new antihypertensive drugs to reach goal BP <95th centile.
ABPM was repeated after 12 and 24 months. Daytime BP did not change significantly after 12 or 24 months.
Night-time BP decreased from 1.57 +- 1.33 to 0.88 +- 0.84 SDS for systolic and from 1.10 +- 1.51 to 0.35 +- 1.18 SDS for diastolic BP after 24 months (p < 0.05). The number of antihypertensive drugs increased from 2.1 +- 0.9 to 2.7 +- 0.8 drugs per patient (p < 0.05), this was especially seen with the use of ACE-inhibitors (increase from 19% to 40% of children, p < 0.05).
In conclusion, this interventional trial demonstrated that, in children after renal transplantation, the control of hypertension, especially at night-time, can be improved by increasing the number of antihypertensive drugs, especially ACE-inhibitors.