Table 3.
Summarized common antihypertensive medications used in kidney transplant patients.
| Antihypertensive classes | Pros | Comments | Cons | Comments |
|---|---|---|---|---|
| Diuretics | ||||
| Loop | - Generally, not the first line antihypertensive medication Used in CsA treated recipients - Used for volume control - May use with ACEI or ARB in TRAS |
- Renal sodium excretion defect in CsA-induced HTN (198) | - Loop diuretic may worsen renal allograft function from redistribution of decreased renal blood flow at juxtamedullary cortex and outer medulla (199) and ↓ oxygenation in medulla due to decreased cortical vascular resistance diverting medullary perfusion (200). | |
| - Electrolyte disturbance | - Hyponatremia- Hypomagnesemia- Hyperuricemia | |||
| Thiazide | - May consider in hypomagnesemic patients who needs volume control from diuresis (154). | - Not the first line antihypertensive medication | - Potential volume depletion - Hyperlipidemia |
|
| - May consider in salt-sensitive HTN from CNIs | - WNK-SPAK-NCC pathway | - Electrolyte disturbance | - Hyponatremia - Hypomagnesemia |
|
| - May use with ACEI or ARB in TRAS | - Hyperuricemia | |||
| CCB | -May improve renal allograft function (201) and lower DGF but inconclusive | -Afferent arteriolar vasodilatation (202) | -Non-dipyridamole CCB is CYP450 inhibitor and increases CNI level | -CYP450 3A4 enzyme inhibitor → ↑CNI and mTOR inhibitors level |
| ACEI/ARB | - Anti-proteinuric | - Hyperkalemia | ||
| - Cardioprotection (203, 204) | - Anemia | |||
| - May use with diuretic in TRAS | - Elevated creatinine | - In the setting of volume depletion, TRAS | ||
| Beta-blockers | -For cardioprotection | - Mask symptoms of hypoglycemia and thyrotoxicosis - Worsening lipid profiles |
||
| - Hyperkalemia | -Especially with mTOR inhibitors | |||
| - Potential rebound HTN | ||||
| Mineralocorticoid receptor antagonists | -Systolic dysfunction | -Safe with using ACEI and ARB | -Hyperkalemia | |
| Alpha1 antagonist | - Comparable to ACEI for BP control - Generally, not the first line antihypertensive agents |
- May need to add other antihypertensive agents | ||
| Alpha2 agonist | - Lower plasma renin activity that modulated renal vascular resistance and subsequently lower MAP (140). - No change in GFR and effective renal plasma flow (141) |
-Potential rebound HTN | -Need to be slowly tapered off if medication discontinuation is needed. | |
ACEI, angiotensin-converting enzyme inhibitors; ARB, angiotensin receptor blockers; CCB, calcium channel blockers; CNI, calcineurin inhibitor; CYP, cytochrome; DGF, delayed graft function; GFR, glomerular filtration rate; mTOR, mammalian target of rapamycin; TRAS, transplant renal artery stenosis; WNK-SPAK-NCC, WNK, With-No-K(Lys)—STE20/SPS1-related proline/alanine-rich kinase—Sodium Chloride Cotransporter.