Improved control of hypertension leads to decrease of proteinuria and stabilisation of graft function in patients after renal transplantation
Abstract
Objective of the study: Hypertension is a frequent complication in children after renal transplantation and the control of post-trans- plant hypertension is unsatisfactorily low. The aim of this prospective interventional study was to improve the control of hype rtensi- on in children after renal transplantation and to evaluate the impact of control of hypertension on graft function and proteinu ria.
Methods: Thirty-six children fulfilled the inclusion criteria ( >= 6 months after transplantation and no acute rejection in the last 3 months). Blood pressure (BP) was measured using ambulatory blood pressure monitoring (ABPM).
Hypertension was defined as mean ambulatory blood pressure >= 95 th -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 blo- od pressure was 395th-centile in treated children), antihypertensive therapy was intensified by adding new antihypertensive dru gs to reach goal BP < 95 th centile.
ABPM was repeated after 12 and 24 months. Results: Daytime BP did not change significantly after 12 or 24 months.
Night-time BP decreased from 1.57+-1.33 SDS to 0.88+-0.84 for systolic and from 1.10+-1.51 SDS to 0.35+-1.18 for diastolic BP after 24 months (p<0.05). The number of antihyper- tensive 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-inhibi tors (increase from 19% to 40% of children, p<0.05).
Proteinuria decreased from 256+-303 to 134 mg/m 2 /day (p=0.002). Graft functi- on worsened in children with sustained hypertension after 2 years (decrease of the Schwartz GFR from 76.1+-14.5 ml/min/1.73m 2 to 66.4+-15.6, p=0.017), but remained stable in children who reached normotension at the end of the 2-yr study (non-significant change of Schwartz GFR from 75.4+-21.9 ml/min/1.73m 2 to 73.8+-18.8).
Conclusions: This interventional trial demonstrated, that in children after renal transplantation the control of hypertension can be improved and that the improved control of hypertension leads to decrease of proteinuria and stabilisation of graft function.