What considerations are important when selecting an initial antihypertensive agent in kidney transplant recipients?
When selecting an initial antihypertensive agent in kidney transplant recipients, important considerations include the patient's volume overload status, pregnancy and lactation status, and evidence of proteinuria. In the early posttransplant period, ARBs should be avoided until kidney transplant function stabilizes, as the acute negative effect of an ARB on GFR can be confused with other causes of graft dysfunction (e.g., rejection). For most other subgroups of transplant patients (e.g., elderly, diabetic), an ARB or CCB should be considered as the first-line antihypertensive agent. The choice of class (i.e., ARB vs. CCB) and specific agent should be based on local availability and cost.