There is limited understanding of why some kidney transplant recipients experience difficult-to-control hypertension, requiring two or more antihypertensive medications, while others need fewer.

: We reviewed pre-kidney transplant cardiovascular imaging and assessed changes in cardiovascular risk factors during the first year post-transplant. Patients were categorized based on the number of antihypertensive medications required at one year: those needing one or fewer and those requiring two or more (difficult-to-control hypertension). The target blood pressure was set at less than 140/90 mmHg.

The study included 245 kidney transplant recipients, with an average age of 43.2 years; 56.3% were male, and 79.2% were living donor recipients. Pre-emptive kidney transplant occurred in 6.5%, and 12.7% had a history of coronary artery disease. Notably, 38% exhibited difficult-to-control hypertension. Significant risk factors included age (p<0.04), pre-kidney transplant hypertension (p<0.007), and diabetes mellitus (p<0.01). Other factors such as dialysis duration, type of dialysis, transplant type, and smoking status showed no significant differences. Abnormal pre-kidney transplant imaging, including reduced ejection fraction, abnormal wall motion, and elevated calcium scores, were associated with a higher risk of difficult-to-control hypertension. Post-kidney transplant factors, such as rejection and changes in serum creatinine, did not differ significantly. Multivariate analysis identified associations with age, male gender, baseline diabetes, baseline hypertension, and the use of two or more antihypertensive medications one month post-transplant.

One year after transplantation, about one-third of kidney transplant recipients exhibited difficult-to-control hypertension, often being older, male, diabetic, and having abnormal pre-transplant cardiovascular imaging.