Inadequate blood pressure control in most kidney transplant recipients and patients with coronary artery disease with and without complications.

BACKGROUND: Hypertension is a widely accepted risk factor for coronary artery disease (CAD), chronic heart failure, and chronic kidney disease (CKD). In kidney transplant recipients, the prevalence of hypertension is 60% to 80%.
OBJECTIVE: To assess the prevalence of target blood pressure in 2 high-risk populations: patients with CAD and kidney allograft recipients. PATIENTS AND METHODS: The study included 520 patients with CAD and 150 kidney allograft recipients. In the CAD population, 30% of patients had diabetes mellitus and 33% had CKD. In kidney allograft recipients, 52% had diabetes (15%) or CKD. Hypertension was diagnosed and treated in 72% of patients with CAD and 90% of kidney allograft recipients. In the CAD population without diabetes but with CKD, target blood pressure was achieved in 47% compared with 31% in the CKD population. Treatment included angiotensin-converting enzyme (ACE) inhibitors in 72% of patients, calcium channel blockers in 28%, diuretic agents in 27%, and beta-blockers in 89%. In allograft recipients, more than 60% required 3 or more hypotension agents. Only 40% demonstrated target blood pressure. In the latter group, the most commonly used hypotension agents were ACE inhibitors in 38%, calcium channel blockers in 84%, diuretic agents in 51%, beta-blockers in 68%, and alpha-blockers in 15%.
CONCLUSION: Both cohorts demonstrated a high prevalence of hypertension. Despite polytherapy, optimal blood pressure control was not achieved in most patients. Greater efforts should be expended to optimize blood pressure control, in particular in the presence of comorbidities. In transplant recipients, beta-blockers are widely used, whereas ACE inhibitors are used infrequently.