Hypertension is a critical issue for kidney patients---the National Kidney Foundation notes that more kidney patients die from cardiovascular problems than from kidney problems. High blood pressure remains a serious concern even after a transplant, as up to 80 percent of kidney transplant recipients continue to experience hypertension. Since data on treatment of post-transplant hypertension are limited, the foundation is unable to recommend any specific class of drug over another. For this reason, the same blood pressure meds that are prescribed before transplant are often given afterward.
ACE Inhibitors
Angiotensin-converting enzyme inhibitors are commonly referred to as ACE inhibitors. ACE inhibitors prevent angiotensin I from being converted into angiotensin II. Since there is less angiotensin II, there is less release of vasopressin and aldosterone, which work to raise blood pressure. Angiotensin I, angiotensin II, vasopressin and aldosterone all work together to regulate blood pressure in such a way that the amount of one of these substances can have an effect on the amount of the others, and consequently on blood pressure. Drugs in this category end with the suffix "opril." Commonly prescribed drugs include lisinopril, enalopril and quinopril.
ARBs
Angiotensin II receptor antagonists, or ARBs, are closely related to ACE inhibitors. This family of drugs acts directly on angiotensin II by blocking the receptors. Like ACE inhibitors, these drugs prevent release of vasopressin and aldosterone. Often ACE inhibitors and ARBs are prescribed together. These drugs end with the suffix "sartan." Commonly prescribed ARBs include losartan, olmesartan, irbesartan, candesartan, olmesartan and valsartan.
Calcium channel blockers
Calcium channel blockers are often referred to as CCBs. These drugs were initially controversial because they act directly on the heart. According to the Mayo Clinic, they prevent calcium from entering cells of the heart and blood vessel walls, resulting in lower blood pressure. This family of drugs ends in the suffix "dipine." Commonly prescribed CCBs include amlodipine, felodipine and isradipine. Some of these are long-acting, and others are short-acting. The kidney foundation reports that short-term studies show a particular class of CCBs called dihydropyridine calcium-channel blockers is associated with higher glomerular filtration rates after transplantation. A high glomerular filtration rate means the kidneys are filtering blood more efficiently.
Diuretics
Diuretics or water pills are also prescribed to lower blood pressure. These drugs reduce blood pressure by lowering the total fluid volume in the body. Since transplant patients are sensitive to changes in hydration, this group of drugs should be used carefully. Commonly prescribed diuretics include hydrochlorothiazide and furosemide.
Risk
The kidney foundation states that there is a moderately strong association between hypertension and progression of kidney disease in transplant patients. While it may be unclear which drugs are best in this population, a retrospective analysis of 29,751 kidney transplant patients shows that the risk of losing the transplanted kidney increases proportionately with increased blood pressure.
