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Abstract

Hypertension is a major risk factor that must be controlled to optimally reduce cardiovascular risk. Previous surveys of our tertiary hypertension referral clinic have shown a high prevalence of controlled hypertension (BP<140/90 mm Hg in 67% patients using HEDIS 3.5 criteria). To examine the prevalence and control of other risk factors, a chart survey was performed for 205 consecutive renal transplant patients meeting the HEDIS 3.5 criteria for inclusion. These patients were seen between Jan 2000 to November 2002 either at the renal tranplant clinic or the hypertension clinic at the Rush-Presbyterian-St.-Luke’s-Medical Center in Chicago. The goal levels for BMI are based on recommendations from the American Dietetic Association, those for the lipid panel are based on NCEP ATP III guidelines and for the diabetic contol, gudelines established by the ADA was used. The prevalence and control of risk factors other than hypertension in our tertiary hypertension clinic are as follows: Table 1

Table 1
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Cardiovascular Risk Factors in Renal Transplant Hypertension

Outcome MeasuresGoal ControlNumber of Charts Measured/ PossiblePrevalenceControl
BMI<27200/20597.56%23%
TOTAL CHOLESTEROL<200 mg/dl205/205100%56%
HDL<40 (M); <50 (F)205/205100%32%
LDL<NCEP goal205/205100%40%
TRIGLYCERIDES<150 mg/dl205/205100%45%
HbA1C<7%52/20525.36%47%
PROTEINURIA<250 mg/dl;*40/20519.5%2%
HOMOCYSTEINE<1431/20515%27%
Outcome MeasuresGoal ControlNumber of Charts Measured/ PossiblePrevalenceControl
BMI<27200/20597.56%23%
TOTAL CHOLESTEROL<200 mg/dl205/205100%56%
HDL<40 (M); <50 (F)205/205100%32%
LDL<NCEP goal205/205100%40%
TRIGLYCERIDES<150 mg/dl205/205100%45%
HbA1C<7%52/20525.36%47%
PROTEINURIA<250 mg/dl;*40/20519.5%2%
HOMOCYSTEINE<1431/20515%27%
*

Proteinuria measured in 24 hr. collection.

Table 1
Open in new tab

Cardiovascular Risk Factors in Renal Transplant Hypertension

Outcome MeasuresGoal ControlNumber of Charts Measured/ PossiblePrevalenceControl
BMI<27200/20597.56%23%
TOTAL CHOLESTEROL<200 mg/dl205/205100%56%
HDL<40 (M); <50 (F)205/205100%32%
LDL<NCEP goal205/205100%40%
TRIGLYCERIDES<150 mg/dl205/205100%45%
HbA1C<7%52/20525.36%47%
PROTEINURIA<250 mg/dl;*40/20519.5%2%
HOMOCYSTEINE<1431/20515%27%
Outcome MeasuresGoal ControlNumber of Charts Measured/ PossiblePrevalenceControl
BMI<27200/20597.56%23%
TOTAL CHOLESTEROL<200 mg/dl205/205100%56%
HDL<40 (M); <50 (F)205/205100%32%
LDL<NCEP goal205/205100%40%
TRIGLYCERIDES<150 mg/dl205/205100%45%
HbA1C<7%52/20525.36%47%
PROTEINURIA<250 mg/dl;*40/20519.5%2%
HOMOCYSTEINE<1431/20515%27%
*

Proteinuria measured in 24 hr. collection.

The above data suggests that hypertension and kidney specialists commonly investigate risk factors other than hypertension and make a reasonable effort to control them. Similar data in non tranplant hypertensive patients has been presented from our center before. It appears that the contol of cardiovascular risk factors, especially the lipid panel is worse in our post transplant hypertensives. A possible explanation for this is the continued use of steroids and other immunosuppressives which adversely affect the glycemic and lipid status of the patient, thereby predisposing a difficulty in controlling these cardiovascular risk factors. A more aggressive approach in control of these risk factors is desirable by both the internists and the specialists.

Cardiovascular Risk Factors, Renal Transplant, Prevalence and Control
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© American Journal of Hypertension, Ltd. 2003
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