| Objectives:1.Understand the clinical characteristics of hypertension after renal transplantation;2. Investigate the effect of different immunosuppressive on PTH occurred;3.Analyze the influence of different immunosuppressive regimens to anti-hypertensive effect of amlodipine.Method:1. We collected and studied the records of2007-2011kidney transplant patient accepted in the Third Xiangya Hospital inpatient and follow-up outpatient. Record the patient’s gender, age, height, weight, underlying diseases, concomitant diseases before transplantation, transplant comorbidities, transplant-related factors, as well as the donor patient’s blood pressure, heart rate, routine blood, routine urine, blood biochemistry situation, taking medicine, etc. According to the standard the study population was divided two groups:people with hypertension after transplantation as the PTH group and people without hypertension after transplantation as non-PTH group. Incidence of PTH、the type of PTH and PTH related factors were analyzed.2. According to the use of immunosuppressant, the patients were divided into FK506group and CsA group, compared and analyzed the effects of different antihypertensive dose and concentration on blood pressures of renal transplant patients.3. According to the use of immunosuppressant, the PTH patients were divided into FK506group and CsA group, studied the effects of different immunosuppressant on antihypertensive efficacy in patients with PTH and compared the differences.Results:1. Selected406cases of renal transplant recipients, the average diastolic blood pressure was93.7±5.0mmHg, mean systolic blood pressure was148.7±5.9mmHg, of which a total of292cases of patients with PTH, PTH rate was71.9%. Which, after renal transplantation0-3,3-6,6-12,12-24and24months there were205,20,22,19,26patients were diagnosed as PTH, respectively, after transplantation0-3,3-6,6-12, 12-24,24months the cumulative incidence rates were50.5%(205/406),55.4%(225/406),60.8%(247/406),65.6%(266/406), respectively. The character of hypertension was the elevating of systolic pressure as well as diastolic pressure (Occupy69.8%), and SBP alone or DBP alone is relatively rare in patients with elevated. In PTH group, the proportion of males, average age, body weight and BMI were significantly higher than non-PTH group (P<0.05); The prevalence of PTH that living related donor is significantly higher than that of allergenic (P<0.05); The prevalence of PTH have no significant difference on the kidney transplant patients with different underlying diseases (P>0.05).2. There were172patients who accepted FK506treatment occurred PTH after renal transplantation, the incidence rate was66.9%(172/257); and there were120patients who treated with CsA occurred PTH after renal transplantation, the incidence rate was80.5%(120/149), the prevalence rate of PTH in CsA-treated group was significant higher than that in FK506-treated group (P<0.05). The level of DBP and SBP in CsA-treated group were higher than FK506group after transplantation1,3,6,12,24months, even there is a significant difference between the groups of3and12months (P<0.05).3. During the treatment about hypertension of post-transplantation, amlodipine can effectively reduce the BP level of patients who with PTH and treat with different immunosuppressant, compliance rate of blood pressure in FK506group higher than CsA group, but no significant difference (P>0.05).Conclusions:1. The incidence of post-transplant hypertension was higher, at71.9%.2. Compared with FK506, the effect of CsA on blood pressure in patients with renal transplantation is more obvious.3. There were certain impacts that different immunosuppressant on antihypertensive efficacy of amlodipine, the buck compliance rate of FK506group is higher than CsA group, but the difference is not significant.Figure5, Table13, References65... |
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