Table 4.
Summarized blood pressure guideline for kidney transplant recipients from different scientific medical societies.
| Recommended BP target (mmHg) | Recommended BP target in special circumstances | Recommended first line antihypertensive medications | Comments | |
|---|---|---|---|---|
| KDIGO 2012 (205) | ≤ 130/80 (2D) | - Time after transplantation - Use of calcineurin inhibitors - Albuminuria - Comorbidity (not graded) |
||
| K/DOQI 2004 (206) | ≤ 130/80 | - Insufficient data to recommend any class of antihypertensive medications | -Integrate non-pharmacological managements including weight loss, dietary sodium restriction, smoking cessation | |
| K/DOQI 2012 (commentary on KDIGO 2012) (207) | ≤ 140/90 | -Individualized choice of antihypertensive agents | ||
| AST 2009 (208) | ≤ 130/80 in adult ≥18 years old (2C) | - No preferred choice of antihypertensive medication - ACEIor ARB if urine protein ≥1 g/day for adult ≥18 years old (Not graded) |
||
| BRA 2011 (209) | Clinic blood pressure ≤ 130/80 | 125/75 mmHg if urine protein/creatinine ratio (PCR) >50 or ACR>35) (2C) |
- RAS may be more effective in the minimization of proteinuria but | - Used with caution in the first 3 months post-transplant (2C) |
| CSN Work Group 2014 (comment on KDIGO 2012) (210) | ≤ 140/90 regardless of the level of albuminuria | ≤ 130/80 in kidney transplant recipients with diabetes | - Based on comorbidities including DM, stroke, CAD, CCB, recent MI, and CHF - RAS blockers should be avoided in the immediate post-transplantation |
|
| ERBP Work Group 2013 (211) | ≤ 130/80 | - ACEI and ARB should be avoided in the first month post-transplant - CCB especially non-hydropyridine CCB may interact with CNI and m-TOR inhibitors. |
- Potential confounding of rising serum creatinine on acute rejection | |
| KHA-CARI 2012 guideline (adaptation of the 2009 KDIGO) (212) | ≤ 130/80 in adult | -Tighter BP control with BP <125/75 in the patient with proteinuria >1 g/day (2C) | -Suggests using CCB as the first line antihypertensive agent; however, this should be balance with the patients' comorbidity and proteinuria. Closely monitor CNI level. | |
| 2017 ACC/AHA (26, 27) | <130/80 mmHg | Reasonable BP target | - CCB is reasonable agent due to improved GFR and kidney survival |
() denotes the strength of recommendation ACC/AHA, American College of Cardiology/American Heart Association; AST, American Society of Transplantation; BP, blood pressure; BRA, British Renal Association; CAD, coronary artery disease; CCB, calcium channel blockers; CHEP, Canadian Hypertension Education Program; CHD, congestive heart failure; CSN, Canadian Society of Nephrology; DM, diabetes mellitus; ERBP, European Renal Best Practice; KDIGO, Kidney Disease: Improving Global Outcomes; K/DOQI, Kidney Disease Outcomes Quality Initiative; KHA-CARI, Kidney Health Australia-Caring of Australians with Renal Impairment; RAS, renin-angiotensin system.