Abstrakt
Hypertension in children after renal transplantation is an important risk factor not only for graft loss but also for cardiovascular morbidity and mortality. The prevalence of posttransplant HTN ranges between 60% and 90%.
The etiology of posttransplant HTN is multifactorial - chronic native kidney disease, immunosuppressive therapy, and chronic allograft dysfunction are the most common causes. Casual blood pressure (BP) should be measured at each outpatient visit; however, ambulatory blood pressure monitoring (ABPM) is the best method for BP evaluation in children after renal transplantation, as it often discloses especially nighttime HTN; given this, it should be regularly performed in each transplanted child.
All classes of antihypertensive drugs are used in the treatment of posttransplant HTN because it has never been proven that one class would be better than another. The most commonly used antihypertensives are calcium channel blockers.
The target BP for transplant children is still a matter of debate; it is recommended to target the same BP as for healthy children, i.e., 90th percentile. Control of HTN in transplanted children still remains poor - only 20-50% of treated children have normal BP.
There is a great potential for improvement of antihypertensive treatment that could potentially result in improvement of both graft and patient survival in children after renal transplantation.