Abstract
Hypertension in children after kidney 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. Office 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 kidney transplantation, as it often discloses masked and nocturnal HTN; given this, it should be regularly performed in every 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. However, in several retrospective studies, the use of calcium channel blockers was associated with better graft function.
Evening medication administration can improve the nocturnal hypertension. 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., <95th percentile.
Lower target BP does not seem to be beneficial. Control of HTN in transplanted children still remains poor - only 20-50% of treated children have normal BP.
There is a great potential for the improvement of antihypertensive treatment that could potentially result in the improvement of both graft and patient survival in children after kidney transplantation.