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摘要: 高血压是器官移植受者术后最常见的重要并发症之一，发生率高达70%～90%不等，明显高于普通人群18.8%~30.0%的高血压发病率。移植后高血压是导致移植物功能丧失和生存预后不良的重要危险因素。高血压与发生心血管并发症风险有显著相关性，可直接导致移植物功能丧失和患者死亡，成为受者带功能死亡的重要病因。然而移植后高血压控制率仅为30%～60%。指南推荐器官移植受者高血压诊断阈值为血压高于 130/80 mmHg；对于老年受者目标血压可放宽至140/90 mmHg；而年轻、肾功能好的患者目标血压亦不应低于120/70 mmHg。指南推荐器官移植受者家庭自我血压监测作为首选的血压监控方式。器官移植受者术后高血压有多种因素,虽然免疫抑制是移植后高血压发病的重要原因，但以治疗高血压为目的调整免疫抑制剂要全面了解免疫状况，权衡利弊，谨慎决定。指南推荐结合危险因素和患者实际临床状态制定个体化联合治疗方案，达到强化降压效果的同时，减轻药物的不良反应。
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表 1 常用免疫抑制剂导致移植术后高血压的相关机制
Table 1. Related mechanisms of hypertension after transplantation caused by the immunosuppressant commonly used
类 别 药物 机制 CNI 他克莫司、环孢素 1. 提高血管张力：降低一氧化氮(NO)、升高内皮素水平
2. 增加交感神经兴奋性
3. 激活血管紧张素-醛固酮系统：血压升高、水钠潴留
4. 激活远端小管的钠-氯协同转运受体：钠重吸收增加，容量过多
5. 肾毒性：通过缩血管效应导致AKI
6. 慢性缺血、肾小球硬化、致间质纤维化和萎缩mTORi 西罗莫司 1. 代谢异常：血脂、血糖异常
2. 致蛋白尿
3. 增加额外的CVE风险糖皮质激素 甲泼尼龙 1. 增加交感神经兴奋性
2. 增加血管张力
3. 增加盐皮质激素活性注：CNI为钙神经蛋白抑制剂；mTORi为哺乳动物雷帕霉素靶蛋白抑制剂；AKI为急性肾功能损害；CVE为心血管事件 
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表 2 改变生活方式治疗的内容、目标和效果
Table 2. The content,goal and effect of treatment of lifestyle change
项 目 目标 预期降压效果 减少钠盐摄入 每日钠盐摄入量逐步降至＜6 g，肾功能正常者可适当补充钾盐 2～8 mmHg 体育运动 强度：中等量，每周3～5次，每次30 min 4～9 mmHg 合理膳食 营养均衡 8～14 mmHg 控制体质量 BMI＜24 kg/m2，腰围＜90 cm(男性)、＜85 cm(女性) 5～20 mmHg/减重10 kg 戒烟 彻底戒烟、避免被动吸烟 限制饮酒 每日饮白酒＜50 ml，或葡萄酒＜100 ml或啤酒＜300 ml，建议戒酒 2～4 mmHg 注：BMI为体质量指数
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